State Plan Amendment and 1915 Waiver Processing

About This Measure

The following measures report the median – or middle of all values – number of days between submission and approval for Medicaid State Plan Amendments (SPAs) and 1915 waiver actions. Data include all actions approved in calendar year 2016.

CMS reviews Medicaid and Children’s Health Insurance Program (CHIP) SPAs and 1915 waiver requests to make sure they comply with the Social Security Act and other related regulations. CMS is committed to working with states to process Medicaid and CHIP SPAs and 1915 waivers as efficiently as possible, in accordance with the statute and regulations. The less time CMS and states spend awaiting approval for SPAs and 1915 waivers, the sooner states can implement their needed program changes and begin claiming federal funds.

Medicaid State Plan Amendments

m58a

Median days between SPA submission and approval: 82 days

In calendar year 2016, CMS approved 839 SPAs. Time to approval includes two parts: (1) the time it takes CMS to conduct the review and (2) the time it takes states to respond to formal requests for additional information.

The median number of days for CMS review was 80.  Not all SPA approvals require additional information from states.  In cases where CMS issued a formal request for additional information, the median number of days for states to provide that information was 90.


1915(b) Waiver Requests, Amendments, and Renewals

m58b

Median days between waiver submission and approval: 79 days

In calendar year 2016, CMS approved 30 1915(b) waiver requests, amendments, and renewals. Time to approval includes two parts: (1) the time it takes CMS to conduct the review and (2) the time it takes states to respond to formal requests for additional information.

The median number of days for CMS review was 79.  Not all 1915 approvals require additional information from states. Fewer than half required additional information in 2016. As a result, the median days for CMS review and between submission and approval are the same. In cases where CMS issued a formal request for additional information, the median number of days for states to provide that information was 38.

1915(c) Waiver Amendments

m58c

Median days between waiver submission and approval: 78 days

In calendar year 2016, CMS approved 150 1915(c) waiver amendments. Time to approval includes two parts: (1) the time it takes CMS to conduct the review and (2) the time it takes states to respond to formal requests for additional information.

The median number of days for CMS review was 78.  Not all 1915 approvals require additional information from states. Fewer than half required additional information in 2016. As a result, the median days for CMS review and between submission and approval are the same. In cases where CMS issued a formal request for additional information, the median number of days for states to provide that information was 53.

1915(c) Waiver Renewals

m58d

Median days between waiver submission and approval: 135 days

In calendar year 2016, CMS approved 43 1915(c) waiver renewals. Time to approval includes two parts: (1) the time it takes CMS to conduct the review and (2) the time it takes states to respond to formal requests for additional information.

The median number of days for CMS review was 100.  Not all 1915 approvals require additional information from states. In cases where CMS issued a formal request for additional information, the median number of days for states to provide that information was 215.


Source: State Plan Amendment and 1915 Waiver Process Improvements to Improve Transparency and Efficiency and Reduce Burden CMCS Informational Bulletin