Department of Health & Human Services
Centers for Medicare & Medicaid Services
601 East 12th Street, Room 355
Kansas City, Missouri 64106-2898
Medicaid and CHIP Operations Group
March 20, 2025
Tyler Sadwith
State Medicaid Director and Chief Deputy Director, Health Care Programs
Department of Health Care Services
Attn: Director’s Office
P.O. Box 997413, MS 0000
Sacramento, California 95899-7413
Re: Section 1135 Flexibilities Requested on January 14, 2025
Dear State Medicaid Director Tyler Sadwith:
On January 8, 2025, the President of the United States issued a proclamation retroactive to January 7, 2025, that the 2025 Southern California Wildfires constitutes an emergency by the authorities vested in the President by the Constitution and the laws of the United States, including sections 201 and 301 of the National Emergencies Act (50 U.S.C. 1601 et seq.), and consistent with section 1135 of the Social Security Act (the Act). On January 7, 2025, pursuant to section 1135(b) of the Act, the Secretary of the United States Department of Health and Human Services (HHS) declared a public health emergency (PHE), invoking the authority to waive or modify certain requirements of titles XVIII, XIX, and XXI of the Act. During a PHE, the Centers for Medicare and Medicaid Services (CMS) may approve the use of section 1135 authority to help ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in CMS programs and to ensure that health care providers that furnish such items and services in good faith, but are unable to comply with one or more of such requirements, may be reimbursed for such items and services and exempted from sanctions for such noncompliance, absent any determination of fraud or abuse. This authority took effect as of January 10, 2025, with a retroactive effective date of January 7, 2025. The emergency period will terminate, and section 1135 waivers will no longer be available, upon termination of the PHE, including any extensions.
CMS granted an initial approval to the state of California for multiple section 1135 flexibilities on January 17, 2025. Your submission to CMS on January 14, 2025 detailed a number of additional federal Medicaid requirements that pose issues or challenges for the health care delivery system in California. Below, please find a response to your requests for waivers or modifications, pursuant to section 1135 of the Act, to address the challenges posed by the 2025 Southern California Wildfires. To the extent the requirements the state requested to waive or modify apply to the Children's Health Insurance Program (CHIP), the state may apply the approved flexibilities to CHIP.
We appreciate the efforts of you and your staff in responding to the needs of the residents and health care community in California. Please contact your state lead if you have any questions or need additional information.
Sincerely,
Courtney Miller
Director
cc: Courtney Miller, Anne Marie Costello, Daniel Tsai
STATE OF CALIFORNIA
APPROVAL OF FEDERAL SECTION 1135 WAIVER REQUESTS
CMS Response: March 20, 2025
To the extent applicable, the following waivers and modifications also apply to CHIP.
Modification of timeframe for timely submission of claims
Pursuant to section 1135(b)(5) of the Act, CMS is modifying the deadline under 42 CFR § 447.45(d)(1), under which the state Medicaid agency must require providers to submit all claims no later than 12 months from the date of service. This deadline is modified to the extent necessary to permit the state Medicaid agency to allow impacted budget units under Local Governmental Agencies (LGAs) in the Targeted Case Management program to submit claims within 18 months of the date of service if the claim was delayed by the PHE. – 42 CFR § 447.45(d)(1)