U.S. flag

An official website of the United States government

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 February 14, 2024, CMS has approved a number of 1902(e)(14)(A) waivers in relation to unwinding related challenges that states face. These include:

  • Strategies to Increase Ex Parte Renewal Rates
  • Strategies to Support Enrollees with Renewal Form Submission or Completion to Reduce Procedural Terminations
  • Strategies to Update Contact Information
  • Strategies to Facilitate Reinstatement of Eligible Individuals for Procedural Reasons

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, including strategies that will support compliance with federal renewal requirements following the end of the Families First Coronavirus Response Act (FFCRA) Medicaid continuous enrollment condition. States that have opted for these strategies, including through mitigation plans, are included under the “Other” categories in the table below.

For additional information on 1902(e)(14)(A) waivers and other strategies to prevent procedural terminations, see SHO letter #22-001 and State Strategies to Prevent Procedural Terminations. Please note that this chart represents unwinding strategies approved under section 1902(e)(14)(A) authority and is not an exhaustive list of strategies a state has otherwise adopted to protect beneficiaries.

The graphic and table below outline the section 1902(e)(14)(A) waivers CMS has approved for states and territories to support the unwinding period, as of February 14, 2024*:

SVG Map

States/TerritoriesStates/Territories TotalsStrategies to Increase Ex Parte Renewal RatesStrategies to Support Enrollees with Renewal Form Submission or Completion to Reduce Procedural TerminationsStrategies to Update Contact InformationStrategies to Facilitate Reinstatement of Eligible Individuals for Procedural ReasonsOther Strategies
Alabama651000
Alaska1062110
Arizona951201
Arkansas621300
California1480312
Colorado530101
Connecticut521101
Delaware840121
District of Columbia1141420
Florida000000
Georgia740201
Hawaii1381211
Idaho320100
Illinois520201
Indiana1581321
Iowa200200
Kansas832210
Kentucky1482121
Louisiana940401
Maine1060211
Maryland1173001
Massachusetts922410
Michigan1261221
Minnesota1491202
Mississippi631200
Missouri730211
Montana330000
Nebraska320100
Nevada1373201
New Hampshire430010
New Jersey840202
New Mexico1243221
New York1070201
North Carolina1170121
North Dakota1051301
Ohio731201
Oklahoma310101
Oregon520300
Pennsylvania320100
Puerto Rico100001
Rhode Island411101
South Carolina1363220
South Dakota110000
Tennessee1592211
Texas411200
Utah832201
USVI110000
Vermont971100
Virginia1022411
Washington521200
West Virginia412001
Wisconsin210100
Wyoming620112
Total waivers by type 20144872735
Total Approved Waivers394     
Total States/Territories with Waivers52     

* Download the full section 1902(e)(14)(A) waiver dataset here.