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State Plan Amendment and 1915 Waiver Processing (Federal)

The following measures report approval times for Medicaid State Plan Amendments (SPAs) and 1915 waiver actions. Measures include:

  • The percentage of SPAs and 1915 waiver actions approved within the first 90 day review period (without a request for additional information [RAI]). 
  • The median – or middle of all values – number of days between submission and approval.
  • The median number of days under CMS review. For actions that required an RAI, this measure includes the combined number of days from both CMS review periods.

The data are shown separately for 4 types of actions:

  • SPAs
  • 1915(b) waiver actions (new waivers, renewals and amendments)
  • 1915(c) waiver amendments
  • 1915(c) waiver renewals

CMS reviews Medicaid 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 SPAs and 1915 waivers as efficiently as possible, in accordance with the statute and regulations. The less time CMS and states spend submitting, reviewing and approving SPAs and 1915 waivers, the sooner states can implement their needed program changes and begin claiming federal funds.

CMS must approve, disapprove, or issue a formal RAI on SPAs and 1915 waivers within 90 calendar days. Once a state responds to an RAI, CMS must approve or disapprove the action within a second 90 day review period. When CMS issues an RAI, the 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 the formal RAI.

Data include all actions approved in calendar years 2016, 2017, and 2018 and the first two quarters of calendar year 2019. For each time period, the total number of approvals is shown in parenthesis. The total number of approvals is the denominator for each measure.

During 2017, CMS started an effort to resolve SPA and waiver actions that had been on RAI awaiting a state response for extended periods of time.  As CMS and states worked together to move those actions to approval, the median processing times increased for some quarters.