U.S. flag

An official website of the United States government

SPA and 1915 Waiver Processing

Transforming Medicaid: Improving Program Efficiency  Between calendar year 2017 and first quarter 2018, process improvements have resulted in significantly reduced approval times.  Approval time for Medicaid SPAs is down 24% Approval time for 1915c waivers is down 54% Approval time for 1915c amendments is down 48% Number of approved Medicaid SPAs is up 21%. Total of 84% within the first 90 days.
The Centers for Medicare & Medicaid Services (CMS) is committed to engaging with states to make the State Plan Amendment (SPA) and 1915(b) and 1915(c) waiver approval processes more transparent, efficient, and less burdensome. CMS conducted an internal assessment and consulted with the National Association of Medicaid Directors (NAMD), state Medicaid directors, staff and other stakeholders to develop strategies to streamline the process. This page provides information on CMS’ SPA and waiver review processes and tools for state use in the development of SPA and 1915 waiver submissions.