Coronavirus and the States: Medicaid Waivers Offer Flexibility; Top Officials Clash

Read Stateline coverage of the latest state action on coronavirus.

The federal agency overseeing Medicaid has moved quickly to grant applications from 34 states to exempt them from several Medicaid rules in order to respond to the coronavirus outbreak.

The states received exemptions from some or all of the same handful of rules. The federal Centers for Medicare and Medicaid Services gave the states permission to:

• Provide Medicaid reimbursement to medical providers who are licensed in other states.
• Eliminate normal requirements for prior authorization for certain medical treatments or prescriptions. Providers are often required to get specific permission from Medicaid for some treatments and medications in order to qualify for reimbursement. The CMS waivers removes that requirement.
• Suspend some of the typical assessments required before approving admission of patients into nursing homes and long-term care facilities for those with mental illness or developmental disabilities. Those assessments can now be done retroactively.
• Reimburse long-term facilities that, as a result of the crisis, are forced to house some patients in unlicensed facilities.
• Suspend normal time limits for considering appeals from Medicaid beneficiaries.

President Donald Trump’s March 13 emergency declaration authorized states to apply for CMS permission to depart from some of the normal rules their Medicaid agencies must observe to qualify for federal matching funds.

Medicaid is the public health plan for the poor that is jointly administered by the federal and state governments. It covers more than 70 million people. The federal government matches dollars the states put up for the program.

Separate from the president’s declaration, in emergency legislation passed earlier this month, Congress increased its Medicaid match rate to the states by 6.2%. Before that, the federal government had provided states between 50% and 78% of their Medicaid revenue depending on state per capita income.