SPA and 1915 Waiver Processing Statistics

The Centers for Medicare & Medicaid Services (CMS) reviews State Plan Amendment (SPA) and 1915 waiver requests to be sure they comply with the Social Security Act and other statute and regulations. CMS is committed to working with states to process SPAs and 1915 waivers efficiently.  Within 90 calendar days, CMS must approve, disapprove, or issue a formal Request for Additional Information (RAI) on SPAs and 1915 waiver actions. Once a state responds to an RAI, CMS must approve or disapprove the action within a second 90-day review period. 

CMS generates annual and quarterly statistics for SPA and 1915 waiver action processing times.  Calendar year 2016 is the first full year before CMS undertook a major initiative to increase the efficiency of SPA and 1915 waiver reviews.  Calendar year 2019 is the last year before COVID-19 public health emergency actions significantly increased SPA and 1915 waiver actions.  In the tables below, CMS displays quarterly metrics for years 2022 to present.  CMS displays annual data for additional years (including annual 2016-2021 statistics) in the Medicaid and CHIP Scorecard. 

Note: In calendar years 2020 through 2023, CMS processed a large volume of SPA and 1915 waiver actions submitted by states in direct response to the COVID-19 public health emergency.  CMS tracked and reported the statistics for those actions separately from the standard actions shown in the charts below. Starting with 2024, CMS no longer separately reported disaster relief actions from standard actions due to the low number of SPAs and 1915c submissions.