Waiver requests flexibility in provider settings, funding, eligibility

OLYMPIA – Washington State has submitted a request to the Centers for Medicare & Medicaid Services (CMS) requesting significant flexibility in how we use Medicaid services and funding to respond to the COVID-19 pandemic.

The request is under Section 1135 of the Social Security Act—commonly known as an 1135 waiver—and comes jointly from HCA, the Washington State Department of Health, and the Washington State Department of Social and Health Services.

"This waiver supports use of telemedicine, and especially our health care facilities and workforce in this time of need," said HCA State Medicaid Director MaryAnne Lindeblad. "It would allow us to get critical flexibility for provider settings and credentials, use of telemedicine, and Medicaid eligibility. We continue working closely with CMS to get to agreement, including through other waiver and amendment means, as quickly as possible so we can most effectively use Medicaid services to support the COVID-19 response."

Examples of the flexibility Washington is seeking through the waiver:

Supports for health care facilities, workforce, and community programs

• Relief from health facility requirements to create new facilities to quickly treat people with COVID-19.
• Relief from certain federal privacy rules that would impede delivery of crisis response services.
• Relief from certain provider licensing to allow physician credentials to be extended to others.
• Ability to allow changes to skilled nursing and other facility rules for new or expanded facilities.
• Flexibility for provision and payment of telehealth services. Apple Health has already opened new billing codes for both telehealth and telephonic services, including for behavioral health services to cover telehealth services in the same manner and at the same rate as in-person care.
• Permit Accountable Communities of Health to coordinate with clinical and community partners on a variety of response strategies.

Supports for patient eligibility and system financing

• Ability to quickly enroll individuals in the Aged, Blind and Disabled Medicaid program, rather than conducting a full asset review before enrollment, which can take up to 90 days.
• Eliminate any co-payments and waive certain spend down provisions for clients.
• Allow Medicaid emergency financing approaches to ensure provider sustainability and retention, particularly for smaller and more vulnerable behavioral health, home care and Tribal health providers.
• Provide enhanced Medicaid funding for certain public health services.
• Allow flexible service funding for participants enrolled in Foundational Community Supports (FCS) to assist with housing and pay for phones.