Following the end of the COVID-19 Public Health Emergency (PHE), many states will need to process an unprecedented volume of renewals and application determinations on a timely basis. This substantial volume of eligibility caseload work, coupled with significant staffing shortages, could cause many states to face substantial operational and system challenges. To support states facing significant operational issues with income and eligibility determination systems and to protect eligible beneficiaries from inappropriate coverage losses during the unwinding period following the end of the COVID-19 PHE, the Centers for Medicare & Medicaid Services (CMS) is providing states the option to request authority under section 1902(e)(14)(A) of the Social Security Act (the Act) in limited circumstances and subject to CMS approval.
As outlined in the March 3, 2022 State Health Official (SHO) letter #22-001, states may request time-limited authority under section 1902(e)(14)(A) of the Act to pursue strategies to support the unwinding period following the end of the COVID-19 PHE that facilitate the renewal process and ensure due process protections during the fair hearing process.
As of February 24, 2023, CMS has approved the following strategies under section 1902(e)(14)(A) of the Act.
- Enroll and/or Renew Individuals Based on Supplemental Nutritional Assistance Program (SNAP) Eligibility (Targeted SNAP Strategy)
- Enroll and/or Renew Individuals Based on Temporary Assistance for Needy Families (TANF) Eligibility (Targeted TANF Strategy)
- Ex Parte Renewal for Individuals with No Income and No Data Returned (Beneficiaries with No Income Renewal)
- Facilitating Renewal for Individuals with no Asset Verification System (AVS) Data Returned within a Reasonable Timeframe (Streamlined Asset Verification)
- Partnering with Managed Care Plans to Update Beneficiary Contact Information (MCO Beneficiary Contact Updates)
- Use of the National Change of Address Database (NCOA) and United States Postal Service (USPS) Returned Mail to Update Beneficiary Contact Information (NCOA and/or USPS Contact Updates)
- Partnering with Enrollment Brokers to Update Beneficiary Contact Information (Enrollment Broker Contact Updates)
- Partnering with Program of All-Inclusive Care for the Elderly (PACE) Organizations to Update Beneficiary Contact Information (PACE Contact Updates)
- Extending Automatic Re-enrollment into Medicaid Managed Care Plans up to 120 Days (MCO Plan Auto-Re-enrollment)
- Extended Timeframe to Take Final Administrative Action on Fair Hearing Requests (Fair Hearing Timeframe Extension)
- Delaying the Resumption of Premiums Until a Full Redetermination is Completed (Premium Resumption Delay)
States may also request authority under section 1902(e)(14)(A) of the Act to implement other strategies needed to ensure that they can establish income and eligibility determination and operations systems that protect beneficiaries during the unwinding period, and some states have done so. These are included under “Other” in the table below. For additional details on these strategies, please see SHO letter #22-001.
The table below outlines the section 1902(e)(14)(A) waivers CMS has approved for states to support the unwinding period:
| States | Targeted SNAP Strategy | Targeted TANF Strategy | Beneficiaries with No Income Renewal | Streamlined Asset Verification | MCO Beneficiary Contact Updates | NCOA and/or USPS Contact Updates | Enrollment Broker and/or PACE Contact Updates | MCO Plan Auto-Re-enrollment | Fair Hearing Timeframe Extension | Premium Resumption Delay | Other | State Totals |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Alabama | X | X | X | X | 4 | |||||||
| Alaska | X | X | X | 3 | ||||||||
| Arizona | X | X | X | X | X | 5 | ||||||
| Arkansas | X | X | X1 | 3 | ||||||||
| California | X | X | X | X | Xp | 5 | ||||||
| Colorado | X | X | X | X | 4 | |||||||
| Connecticut | ||||||||||||
| Delaware | X | X | X | X | 4 | |||||||
| District of Columbia | X | X | X | Xe,p | X | 6 | ||||||
| Florida | ||||||||||||
| Georgia | X | X | X | X | X | X | X | 7 | ||||
| Hawaii | X | X | X | X | X | 5 | ||||||
| Idaho | X | X | 2 | |||||||||
| Illinois | X | X | X | X | X | 5 | ||||||
| Indiana | X | X | X | X | Xe | X | 6 | |||||
| Iowa | X | 1 | ||||||||||
| Kansas | X | X | X | X | 4 | |||||||
| Kentucky | X | X | X | X | X | X | 6 | |||||
| Louisiana | X | X | X | X | X | Xe,p | X | 8 | ||||
| Maine | X | 1 | ||||||||||
| Maryland | X | 1 | ||||||||||
| Massachusetts | X | X | X2 | 3 | ||||||||
| Michigan | X | Xe | X | 3 | ||||||||
| Minnesota | X | X | 2 | |||||||||
| Mississippi | X | X | X | X | 4 | |||||||
| Missouri | X | X | X | X | X | X | X | 7 | ||||
| Montana | ||||||||||||
| Nebraska | X | 1 | ||||||||||
| Nevada | X | X | X | X | X | 5 | ||||||
| New Hampshire | X | X | 2 | |||||||||
| New Jersey | X | X | X | X | 4 | |||||||
| New Mexico | X | X | X | X | X | X | 6 | |||||
| New York | ||||||||||||
| North Carolina | X | X | X | X | X | 5 | ||||||
| North Dakota | X | Xp | 2 | |||||||||
| Ohio | X | X | X | X | 4 | |||||||
| Oklahoma | ||||||||||||
| Oregon | X | X | X | Xp | X3 | 5 | ||||||
| Pennsylvania | X | 1 | ||||||||||
| Rhode Island | X | 1 | ||||||||||
| South Carolina | X | X | X | 3 | ||||||||
| South Dakota | ||||||||||||
| Tennessee | X4 | X | X | X | X | 5 | ||||||
| Texas | X | X | X | 3 | ||||||||
| Utah | X | X | X | X | X | 5 | ||||||
| Vermont | X | X | X | X | 4 | |||||||
| Virginia | X | X | X | Xe,p | 5 | |||||||
| Washington | X | 1 | ||||||||||
| West Virginia | ||||||||||||
| Wisconsin | ||||||||||||
| Wyoming | X | X | 2 | |||||||||
| Total waivers by type | 16 | 4 | 28 | 19 | 31 | 30 | 11 | 8 | 13 | 3 | ||
| Total Approved Waivers | 163 | |||||||||||
| Total States with Waivers | 43 | |||||||||||
* indicates Other approval
Xe - State has an approved Section 1902(e)(14)(A) waiver that authorizes the state to accept updated in-state enrollee contact information received from enrollment brokers without additional confirmation from the beneficiary.
Xp - State has an approved Section 1902(e)(14)(A) waiver that authorizes the state to accept updated in-state enrollee contact information received from PACE organizations without additional confirmation from the beneficiary.
Arkansas1 - State has an approved Section 1902(e)(14)(A) waiver that authorizes the state to accept updated in-state enrollee contact information received from the state's Qualified Health Plans (QHP) without additional confirmation from the beneficiary.
Massachusetts2 - State has an approved Section 1902(e)(14)(A) waiver that authorizes the state to accept updated in-state enrollee contact information received from the state's Department of Housing and Community Development (DHCD) without additional confirmation from the beneficiary.
Oregon3 - State has an approved Section 1902(e)(14)(A) waiver that authorizes the state to accept updated in-state enrollee contact information received from the state's contracted care coordination entities which serve the state's fee-for service population without additional confirmation from the beneficiary.
Tennessee4 - State has an approved Section 1902(e)(14)(A) waiver that authorizes the state to apply the “Targeted SNAP Strategy” to select non-MAGI eligibility groups.