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Emergency Preparedness and Response for Home and Community Based (HCBS) 1915(c) Waivers

Appendix K is a standalone appendix that may be utilized by states during emergency situations to request amendment to approved 1915(c) waivers. It includes actions that states can take under the existing Section 1915(c) home and community-based waiver authority in order to respond to an emergency.  Other activities may require the use of various other authorities such as the Section 1115 demonstrations or the Section 1135 authorities.  This appendix may be completed retroactively as needed by the state.

Appendix K Templates and Instructions

Approved COVID-19 Appendix K Documents

Note: Information on the underlying waivers can be found on the State Waiver List

State Approval Letter(s) Approved Appendix K
Alaska Approval Letter (PDF, 108.77 KB) Appendix K - AK Combined (PDF, 277.94 KB)
Arizona Approval Letter (PDF, 446.73 KB)   AHCCCS 1115 Demonstration (1-W-00275/9) Appendix K (PDF, 444.29 KB)
California Approval Letter (PDF, 108.14 KB)   CA.0139 Appendix K (PDF, 174.59 KB)
CA.0141 Appendix K (PDF, 161.82 KB)
CA.0183 Appendix K (PDF, 163.69 KB)
CA.0336 Appendix K (PDF, 127.16 KB)
CA.0431 Appendix K (PDF, 134.94 KB)
Colorado Approval Letter (PDF, 134.69 KB) Appendix K - CO Combined (PDF, 454.8 KB)
Connecticut Approval Letter (PDF, 136.49 KB)

CT.0140 Appendix K (PDF, 100.12 KB)
CT.0301 Appendix K (PDF, 106.33 KB)
CT.0302 Appendix K (PDF, 136.46 KB)
CT.0653 Appendix K (PDF, 149.76 KB)
CT.0993 Appendix K (PDF, 130.22 KB)
CT.1085 Appendix K (PDF, 134.04 KB)
CT.4110 Appendix K (PDF, 98.49 KB)
Appendix K - CT 0081, 0426, 0437 Combined (PDF, 142.2 KB)

Delaware Approval Letter (PDF, 107.92 KB) DE.0009 Appendix K (PDF, 155.42 KB)
Hawaii Approval Letter (PDF, 107.53 KB)   HI.0013 Appendix K (PDF, 237.55 KB)
Iowa Approval Letter (PDF, 132.86 KB)   Appendix K - IA Combined (PDF, 159.21 KB)
Kansas Approval Letter (PDF, 135.35 KB)   Appendix K - KS Combined (PDF, 194.96 KB)
Kentucky Approval Letter (PDF, 108.93 KB) Appendix K - KY Combined (PDF, 133.28 KB)
Minnesota Approval Letter (PDF, 108.19 KB) Appendix K - MN Combined (PDF, 154.31 KB)
Mississippi Approval Letter (PDF, 108.03 KB) MS.0225 Appendix K (PDF, 149.03 KB)
MS.0272 Appendix K (PDF, 109.02 KB)
MS.0355 Appendix K (PDF, 101.33 KB)
MS.0366 Appendix K (PDF, 129.63 KB)
New Mexico Approval Letter (PDF, 108.16 KB) Appendix K - NM Combined (PDF, 283.48 KB)
New York Approval Letter (PDF, 107.5 KB) NY.0238 Appendix K (PDF, 724.39 KB)
North Carolina Approval Letter (PDF, 107.06 KB)   NC.0132 Appendix K (PDF, 429.64 KB)
NC.0423 Appendix K (PDF, 178.93 KB)
NC.1326 Appendix K (PDF, 174.86 KB)
NC.4141 Appendix K (PDF, 395.88 KB)
 
North Dakota Approval Letter (PDF, 109.3 KB) ND.0037 Appendix K (PDF, 295.85 KB)
ND.0273 Appendix K (PDF, 166.71 KB)
ND.0568 Appendix K (PDF, 171.77 KB)
ND.0834 Appendix K (PDF, 160.87 KB)
ND.0842 Appendix K (PDF, 147.58 KB)
Oklahoma Approval Letter (PDF, 108.57 KB) OK.0256 Appendix K (PDF, 353.79 KB)
OK.0343 Appendix K (PDF, 204.87 KB)
OK.0351 Appendix K (PDF, 193.48 KB)
OK.0811 Appendix K (PDF, 239.06 KB)
Appendix K - OK 0179, 0399 Combined (PDF, 262.53 KB)
Pennsylvania

Approval Letter (PDF, 103.61 KB)

Approval Letter 2 (PDF, 133.84 KB)

PA.0147 Appendix K (PDF, 122.67 KB)
PA.0235 Appendix K (PDF, 95.33 KB)
PA.0324 Appendix K -  Amended
PA.0354 Appendix K (PDF, 149.39 KB)
PA.0386 Appendix K (PDF, 95.01 KB)
PA.0593 Appendix K (PDF, 160.92 KB)
PA.1486 Appendix K (PDF, 107.36 KB)

Rhode Island Approval Letter (PDF, 394.77 KB)

Comprehensive 1115 Demonstration (11-W-00242/1) (PDF, 74.83 KB)

South Dakota Approval Letter (PDF, 108.38 KB)   SD.0044 Appendix K (PDF, 101.73 KB)
SD.0189 Appendix K (PDF, 141.22 KB)
Washington

Approval Letter (PDF, 135.43 KB)  (03/19/2020)

Approval Letter (PDF, 106.87 KB) (03/23/2020)

WA.0049 Appendix K (PDF, 145.83 KB)
WA.0409 Appendix K (PDF, 574.07 KB)
WA.0410 Appendix K (PDF, 598.92 KB)
WA.0411 Appendix K (PDF, 496.94 KB)
WA.0443 Appendix K (PDF, 135.29 KB)
WA.1086 Appendix K (PDF, 109.36 KB)
WA.1186 Appendix K (PDF, 702.08 KB)
WA.40669 Appendix K (PDF, 461.7 KB)

West Virginia Approval Letter (PDF, 104.05 KB)

WV.0133 Appendix K (PDF, 79.35 KB)
WV.0134 Appendix K (PDF, 77.36 KB)
WV.0876 Appendix K (PDF, 77.08 KB)
WV.1646 Appendix K (PDF, 105.09 KB)

Wyoming  Approval Letter (PDF, 132.27 KB) Appendix K - WY Combined (PDF, 159.48 KB)