The Centers for Medicare & Medicaid Services (CMS) granted an initial approval to the State of Washington for multiple section 1135 flexibilities on March 19, 2020.  Your initial 1135 request included a request for additional flexibilities we can now approve.  Attached, please find a response to your requests for waivers or modifications, pursuant to section 1135 of the Social Security Act (Act), to address the challenges posed by COVID-19.  This approval addresses those requests related to Medicaid.

The Centers for Medicare & Medicaid Services (CMS) granted an initial approval to the state of Arizona for multiple section 1135 flexibilities on March 23, 2020.  Your March 17, 2020 communication and follow-up communication to CMS on April 17, 2020 detailed a number of additional federal requirements that also pose issues or challenges for the health care delivery system in Arizona and requested a waiver or modification of those additional requirements.

The Centers for Medicare & Medicaid Services (CMS) granted an initial approval to the state of Iowa for multiple section 1135 flexibilities on March 25, 2020. Your follow-up communication to CMS on April 1, 2020, detailed a number of additional federal requirements that also pose issues or challenges for the health care delivery system in Iowa and requested a waiver or modification of those additional requirements.

The Centers for Medicare & Medicaid Services (CMS) granted an initial approval to the state of Arkansas for multiple Section 1135 flexibilities on April 2, 2020.  Your follow-up communication to CMS on April 23, 2020 detai1ed a number of additional federal requirements that also pose issues or challenges for the health care delivery system in Arkansas and requested a waiver or modification of those additional requirements.