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Using Section 1115 Demonstrations for Disaster Response

In the event of Federal designation of a natural disaster, public health emergency, or other sudden emergency threats to human lives, section 1115 authority has been used to assist states to address the direct impact of such public emergency on Medicaid and Children’s Health Insurance Program (CHIP) programs.

Section 1115 of the Social Security Act (the Act) provides the U.S. Department of Health and Human Services Secretary with authority to waive certain sections of title XIX (Medicaid) and title XXI CHIP) and to provide expenditure authority for costs not otherwise matchable under title XIX or title XXI. The purpose of section 1115(a) authority is to develop research and demonstration projects that test innovations in healthcare delivery, access, quality, or financing that are likely to further the objectives of the Medicaid and/or CHIP programs.

States can request a new Medicaid and/or CHIP section 1115(a) demonstration, or amend or extend its current section 1115(a) demonstration to address the impact of the Federally-designated public emergency on its program(s) verbally or in writing to it’s the Centers for Medicare & Medicaid Services (CMS) section 1115 Project Officer and/or the Associate Regional Administrator for the Division of Medicaid and Children's Health.

States should identify the administrative and medical services flexibilities they believe they need to respond to the public emergency and CMS will work with the state to confirm and determine the scope of program changes needed in an expedited timeframe. Budget neutrality for section 1115 demonstrations related to Federally-designated public emergencies is presumed to be met; thereby states are not required to submit a budget neutrality analysis in such requests.

States may submit completed 1115 applications to 1115demorequests@cms.hhs.gov.

CMS may waive, in whole or in part, the Federal and State public notice and comment procedures (applicable pursuant to 59 Federal Register 49249 (September 27, 1994) or 42 Code of Federal Regulations (CFR) §431.408(a)) to expedite a decision on the state's section 1115 request to address a public emergency. States will be permitted to discharge its basic responsibilities required by 42 CFR §431.412 for submitting applications to CMS for new or extended demonstrations. A State must meet all of the following criteria to obtain such an exemption from the normal public notice process requirements:

  1. The state acted in good faith, and in a diligent, timely, and prudent manner
  2. The circumstances constitute an emergency and could not have been reasonably foreseen
  3. Delay would undermine or compromise the purpose of the demonstration and be contrary to the interests of beneficiaries

CMS will publish any disaster exemption determinations within 15 days of approval, as well as the revised timeline for public comment or post-award processes, if applicable.

CMS section 1115 information, requests, and approvals.