Many states are looking to adapt their Medicaid programs to address new challenges related to COVID-19, including by increasing coverage and protection for Medicaid enrollees. The Centers for Medicare and Medicaid Services (CMS) has issued guidance on the types of measures that states can take to change their Medicaid programs.

In an FAQ addressed to state Medicaid and Children’s Health Insurance Program agencies, CMS addressed questions from states, saying that states may have flexibility to cover telehealth services, accelerate or relax prior authorization requirements, expand provider networks, extend Medicaid eligibility, and suspend copayments, although some of these measures may require CMS’ waiver of federal requirements or approval of changes to the state Medicaid plan.

On March 22, CMS released checklists and tools that guide Medicaid programs through the processes of seeking expedited approval of such changes and waivers, including section 1115 demonstration waivers, section 1135 waivers, Appendix K of section 1915(c) home and community-based services waivers, and disaster amendments to the state plan. In the associated press release, the Trump Administration indicated that the tools could be used by states to “access emergency administrative relief, make temporary modifications to Medicaid eligibility and benefit requirements, relax rules to ensure that individuals with disabilities and the elderly can be effectively served in their homes, and modify payment rules to support health care providers impacted by the outbreak.” CMS is providing states the options to request waivers effective retroactively to March 1.

Even before CMS issued such guidance, Medicaid agencies in both Republican- and Democrat-led states have sought out waivers in connection with COVID-19. As discussed in a previous Crowell & Moring blog post, CMS has already approved section 1335 waivers for Florida and Washington. Additionally, CMS has approved COVID-19 related amendments to the Pennsylvania, Washington, and West Virginia 1915(c) Home and Community-Based Services waivers. Other state waivers are still pending, including those submitted by Arizona and Iowa.

One of the main focuses for states in their waiver applications has been the elimination of cost-sharing for COVID-19 testing. Some state governors, including Governors Gretchen Whitmer of Michigan, Andrew Cuomo of New York, and Andy Beshear of Kentucky, have separately issued directives eliminating copays and cost sharing related to COVID-19 testing, and in some instances treatment, for either the state Medicaid programs or state-regulated insurers more generally.

Some of these states have sought to limit Medicaid coverage and expansion in the past. For instance, Arizona, Florida, Iowa, and Kentucky have been granted waivers eliminating retrospective eligibility for Medicaid enrollees. Even as these states now take measures to ensure continued access to care during the public health crisis, past waivers of Medicaid beneficiary protections may remain in place.

Additionally, some states have continued pursuing measures to tighten Medicaid eligibility as they simultaneously respond to COVID-19 challenges. On March 16, Oklahoma published a Medicaid section 1115 waiver and initiated a public comment period for a waiver that would include a work requirement for enrollee eligibility. Utah also continues to pursue a requirement that individuals complete a certain number of job searches in the first 90 days of Medicaid eligibility.