COVID-19 PHE Unwinding Section 1902(e)(14)(A) Waiver Approvals

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 August 18, 2023, CMS has approved a number of 1902(e)(14)(A) waivers in relation to unwinding related challenges that states face.

Arizona¹ - State has an approved Section 1902(e)(14)(A) waiver in the “Other” category that authorize the state to temporarily permit Medicaid managed care plans to assist their enrollees in completing the Medicaid renewal process, including completing certain parts of their renewal forms.

Arkansas² - State has two approved Section 1902(e)(14)(A) waivers in the “Other” category that authorize the state to temporarily: 1) accept updated in-state enrollee contact information received from the state's Qualified Health Plans (QHP) without additional confirmation from the beneficiary; & 2) permit Medicaid managed care plans to assist their enrollees in completing the Medicaid renewal process, including completing certain parts of their renewal forms.

California³ - State has two approved Section 1902(e)(14)(A) waivers in the “Other” category that authorize the state to temporarily: (1) waive the beneficiary asset test at renewal for individuals enrolled on a non-MAGI basis; & 2) reinstate eligibility effective on the individual’s prior termination date for individuals who were disenrolled based on a procedural reason and are subsequently redetermined eligible for Medicaid during the state’s reconsideration period. The state also has an approved Section 1902(e)(14)(A) waiver that authorizes the state to temporarily extend the timeframe permitted for beneficiaries to request a fair hearing to 120 days from the date the notice of action is mailed.

Delaware⁴ - State has an approved Section 1902(e)(14)(A) waiver in the “Other” category that authorizes the state to temporarily reinstate eligibility effective on the individual’s prior termination date for individuals who were disenrolled based on a procedural reason and are subsequently redetermined eligible for Medicaid during the state’s reconsideration period.

Hawaii⁵ - State has an approved Section 1902(e)(14)(A) waiver in the “Other” category that authorizes the state to temporarily reinstate eligibility effective on the individual’s prior termination date for individuals who were disenrolled based on a procedural reason and are subsequently redetermined eligible for Medicaid during the state’s reconsideration period.

Kansas⁶ - State has three approved Section 1902(e)(14)(A) waivers in the “Other” category that authorize the state to temporarily: (1) permit Medicaid managed care plans to assist their enrollees in completing the Medicaid renewal process, including completing certain parts of their renewal forms; (2) reinstate eligibility effective on the individual’s prior termination date for individuals who were disenrolled based on a procedural reason and are subsequently redetermined eligible for Medicaid during the state’s reconsideration period;  & (3) permit applicants and beneficiaries to designate an authorized representative via the telephone without requiring a signed designation from the applicant and beneficiary submitted to the state Medicaid agency.

Kentucky⁷ - State has four Section 1902(e)(14)(A) waivers in the “Other” category that authorize the state to temporarily: (1) waive the recording of the telephonic signature for applicants and beneficiaries; (2) permit Medicaid managed care plans to assist their enrollees in completing the Medicaid renewal process, including completing certain parts of their renewal forms; (3) reinstate eligibility effective on the individual’s prior termination date for individuals who were disenrolled based on a procedural reason and are subsequently redetermined eligible for Medicaid during the state’s reconsideration period; & (4) waive the beneficiary asset test at renewal for individuals enrolled on a non-MAGI basis.

Maine⁸ - State has two approved Section 1902(e)(14)(A) waivers  in the "Other" category that authorize the state to temporarily (1) accept updated in-state enrollee contact information received from the state's Dual Eligible Special Needs Program without additional confirmation from the beneficiary; & (2) reinstate eligibility effective on the individual’s prior termination date for individuals who were disenrolled based on a procedural reason and are subsequently redetermined eligible for Medicaid during the state’s reconsideration period.

Maryland⁹ - State has five approved Section 1902(e)(14)(A) waivers in the "Other" category that authorize the state to temporarily: (1) permit applicants and beneficiaries to designate an authorized representative via the telephone without requiring a signed designation from the applicant and beneficiary submitted to the state Medicaid agency; (2) waive the recording of the telephonic signature for applicants and beneficiaries; (3) waive the beneficiary asset test at renewal for individuals enrolled on a non-MAGI basis; 4) permit Medicaid managed care plans to assist their enrollees in completing the Medicaid renewal process, including completing certain parts of their renewal forms; (5) temporary suspend the requirement to cooperate with the agency in establishing the identity of a child's parents and in obtaining medical support.

Massachusetts¹⁰ - State has three approved Section 1902(e)(14) waivers in the "Other" category that authorize the state to temporarily: (1) accept updated in-state enrollee contact information received from the state's Department of Housing and Community Development (DCHD) without additional confirmation from the beneficiary;  (2) accept updated in-state enrollee contact information received from a trusted third-party data source only if it is more recent than the contact information on file for beneficiaries for whom the state received returned mail with no forwarding address, without additional confirmation from the individual; and (3) permit applicants and beneficiaries to designate an authorized representative via the telephone without requiring a signed designation from the applicant and beneficiary submitted to the state Medicaid agency.    

Michigan¹¹ - State has two approved Section 1902(e)(14)(A) waivers in the "Other" category that authorize the state to temporarily: 1) permit Medicaid managed care plans to assist their enrollees in completing the Medicaid renewal process, including completing certain parts of their renewal forms; & 2) reinstate eligibility effective on the individual’s prior termination date for individuals who were disenrolled based on a procedural reason and are subsequently redetermined eligible for Medicaid during the state’s reconsideration period.

Minnesota¹² - State has an approved Section 1902(e)(14)(A) waiver in the "Other" category that authorizes the state to temporarily waive the recording of the telephonic signature for applicants and beneficiaries.

Nevada¹³ - State has four approved Section 1902(e)(14)(A) waivers in the “Other” category that authorize the state to temporarily: 1) waive the beneficiary asset test at renewal for individuals enrolled on a non-MAGI basis; 2) permit applicants and beneficiaries to designate an authorized representative via the telephone without requiring a signed designation from the applicant and beneficiary submitted to the state Medicaid agency; 3) permit Medicaid managed care plans to assist their enrollees in completing the Medicaid renewal process; & 4) renew Medicaid eligibility for individuals with only Title II or other stable sources of income.

New Hampshire¹⁴ - State has an approved Section 1902(e)(14)(A) waiver in the "Other" category that authorize the state to temporarily streamline asset verification at renewal to assume there has been no change in resources for non-MAGI individuals, which cannot be verified through the AVS, when the state has information in the case file that the total countable resources, excluding trusts, are $999.99 or less. 

New Jersey¹⁵ - State has an approved Section 1902(e)(14)(A) waiver in the “Other” category that authorizes the state to temporarily permit the state to  renew Medicaid eligibility for individuals with only Title II or other stable sources of income. The state also has an approved 1902(e)(14)(A) waiver that permits that state to temporarily adopt certain recommended fair hearing decisions issued by administrative law judges (ALJs) as final fair hearing decisions without agency review

New York¹⁶ - State has an approved Section 1902(e)(14)(A) waiver that authorizes the state to temporarily utilize the Targeted SNAP Strategy for the state's CHIP population.

North Carolina¹⁷ - State has an approved Section 1902(e)(14)(A) waiver in the “Other” category that authorizes the state to temporarily reinstate eligibility effective on the individual’s prior termination date for individuals who were disenrolled based on a procedural reason and are subsequently redetermined eligible for Medicaid during the state’s reconsideration period.

North Dakota¹⁸ - State has three approved Section 1902(e)(14)(A) waivers in the “Other” category that authorize the state to temporarily: 1) renew Medicaid eligibility for individuals with only Title II or other stable sources of income; 2) permit Medicaid managed care plans to assist their enrollees in completing the Medicaid renewal process, including completing certain parts of their renewal forms; & 3) suspend the requirement to cooperate with the agency in establishing the identity of a child's parents and in obtaining medical support.

Ohio¹⁹ - State has an approved Section 1902(e)(14)(A) waiver in the “Other” category that authorizes the state to temporarily permit Medicaid managed care plans to assist their enrollees in completing the Medicaid renewal process, including completing certain parts of their renewal forms.

Oregon²⁰ - State has an approved Section 1902(e)(14)(A) waiver in the "Other" category 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.

Rhode Island²¹ - State has two approved Section 1902(e)(14)(A) waivers in the “Other” category that authorize the state to temporarily: 1) permit Medicaid managed care plans to assist their enrollees in completing the Medicaid renewal process, including completing certain parts of their renewal forms; & 2) waive the beneficiary asset test at renewal for individuals enrolled on a non-MAGI basis.

South Carolina²² - State has five approved Section 1902(e)(14)(A) waivers in the "Other" category that authorize the state to temporarily: 1) permit applicants and beneficiaries to designate an authorized representative via the telephone without requiring a signed designation from the applicant and beneficiary submitted to the state Medicaid agency; 2) waive the recording of the telephonic signature for applicants and beneficiaries; 3) reinstate eligibility effective on the individual’s prior termination date for individuals who were disenrolled based on a procedural reason and are subsequently redetermined eligible for Medicaid during the state’s reconsideration period; 4) authorize Medicaid managed care plans to assist their enrollees in completing the Medicaid renewal process, including completing certain parts of their renewal forms.; & 5) suspend the requirement to cooperate with the agency in establishing the identity of a child's parents and in obtaining medical support.

Tennessee²³ - State has three approved Section 1902(e)(14)(A) waivers in the "Other" category that authorize the state to temporarily: 1) permit applicants and beneficiaries to designate an authorized representative via the telephone without requiring a signed designation from the applicant and beneficiary submitted to the state Medicaid agency; 2) permit Medicaid managed care plans to assist their enrollees in completing the Medicaid renewal process, including completing certain parts of their renewal forms; & 3) reinstate eligibility effective on the individual’s prior termination date for individuals who were disenrolled based on a procedural reason and are subsequently redetermined eligible for Medicaid during the state’s reconsideration period.

Utah²⁴ - State has an approved Section 1902(e)(14)(A) waiver in the “Other” category that authorizes the state to temporarily permit Medicaid managed care plans to assist their enrollees in completing the Medicaid renewal process, including completing certain parts of their renewal forms.    

Vermont²⁵ - State has two approved Section 1902(e)(14)(A) waivers in the "Other" category that authorize the state to temporarily: 1) suspend the requirement that individuals apply for certain other benefits to which they are entitled as a condition of Medicaid eligibility; & 2) waive the recording of the telephonic signature to beneficiaries receiving long-term care in an institution as well as beneficiaries receiving home and community-based services (HCBS) through the following programs: Choices for Care, Brain Injury Program, Developmental Disabilities, and Intensive HCBS. 

Virginia²⁶ - State has three approved Section 1902(e)(14)(A) waivers in the "Other" category that authorize the state to temporarily: 1) permit applicants and beneficiaries to designate an authorized representative via the telephone without requiring a signed designation from the applicant and beneficiary submitted to the state Medicaid agency; 2) permit Medicaid managed care plans to assist their enrollees in completing the Medicaid renewal process, including completing certain parts of their renewal forms; & 3) reinstate eligibility effective on the individual’s prior termination date for individuals who were disenrolled based on a procedural reason and are subsequently redetermined eligible for Medicaid during the state’s reconsideration period.

Wyoming²⁷ - State has an approved Section 1902(e)(14)(A) waiver in the “Other” category that authorizes the state to temporarily reinstate eligibility effective on the individual’s prior termination date for individuals who were disenrolled based on a procedural reason and are subsequently redetermined eligible for Medicaid during the state’s reconsideration period.