The following measures report approval times for Medicaid State Plan Amendments (SPAs) and 1915 waiver actions. 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. The measures reported for each action type (SPAs, 1915(b) waiver actions [new waivers, renewals, and amendments], 1915(c) waiver amendments, and 1915(c) waiver renewals) are shown in the table below.  

CMS reviews Medicaid SPAs and 1915 waiver requests to make sure they comply with the Social Security Act and other related regulations. CMS must approve, disapprove, or issue a formal request for additional information (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. The figure below shows the review process.

Data include all actions approved in calendar years (CY) 2016, 2017, 2018, 2019 and 2020. For each time period, the total number of approvals is shown in parentheses. The total number of approvals is the denominator for each measure.

During CY 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 time periods.

During CY 2020, CMS approved 1915(c) waiver amendments related to the COVID-19 public health emergency. Those amendments, referred to as Appendix Ks, are processed on expedited timeframes and significantly skewed the processing data for CY 2020. During CY 2020, CMS also approved COVID-19 related SPAs on expedited timeframes, which skewed the processing time data. The graphs below include information on processing only for non-COVID-19 1915(c) waiver amendments and SPAs. Refer to the table for a comparison of processing times for COVID-19 related and non-COVID-19 related 1915(c) waiver amendments and SPAs in CY 2020.

Source: CMCS Informational Bulletin and analysis of administrative data.