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
August 26, 2026
Ryan Moran, Director
Trinity Wilson, State Medicaid Director
Washington State Health Care Authority
Post Office Box 45502
Olympia, WA 98504-5010
Re: Section 1135 Flexibilities Requested on August 13, 2026
Dear Director Wilson:
On August 3, 2026, the President of the United States issued a proclamation retroactive to August 1, 2026, that the 2026 Washington Wildfires constitute 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 August 7, 2026, 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 August 7, 2026, with a retroactive effective date of August 1, 2026. The emergency period will terminate, and section 1135 waivers will no longer be available, upon termination of the PHE, including any extensions.
Your submission to CMS on August 13, 2026 detailed federal Medicaid requirements that pose issues or challenges for the health care delivery system in Washington. Below, please find a response to each of your requests for waivers or modifications, pursuant to section 1135 of the Act, to address the challenges posed by the 2026 Washington 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.
States are responsible for following all applicable federal law and regulations when they claim and use federal Medicaid funds and must fully comply with all applicable Medicaid statutes and regulations, except where specific provisions have been expressly waived or modified temporarily under 1135 authority. States must maintain effective systems and safeguards to prevent, detect, and address any fraud, waste, or abuse in the delivery of and payment for Medicaid services, including referrals to law enforcement when appropriate. States should have heightened monitoring and oversight mechanisms in place featuring robust internal controls to identify and remediate all vulnerabilities (including, but not limited to, fraud, waste, or abuse and beneficiary access issues) inherent in public health emergencies.
We appreciate the efforts of you and your staff in responding to the needs of the residents and health care community in Washington. Please contact your state lead if you have any questions or need additional information.
Sincerely,
Courtney Miller
Director
cc:
Dan Brillman
Caprice Knapp
Anne Marie Costello
Courtney Miller
Barbara Richards
WASHINGTON
APPROVAL OF FEDERAL SECTION 1135 WAIVER REQUESTS
CMS Response: August 26, 2026
To the extent applicable, the following waivers and modifications also apply to CHIP.
Long Term Services and Supports (LTSS)
PASRR
Pursuant to section 1135(b)(5) of the Act, CMS approves a modification of Section 1919(e)(7) and 42 C.F.R. § 483.112 to allow Level I and Level II assessments to be waived by the state for 30 days from admission. After 30 days, Level I assessments should be conducted with reasonable promptness and Level II assessments should be coordinated with the resident review.
Additionally, please note that per 42 C.F.R. § 483.106(b)(4), new preadmission Level I and Level II screens are not required for residents who are being transferred between nursing facilities (NF). If the NF is not certain whether a Level I had been conducted at the resident's evacuating facility, a Level I can be conducted by the admitting facility during the first few days of admission as part of intake and transfers. Positive Level I screens necessitate a Resident Review.
HCBS Settings Requirements
Pursuant to section 1135(b)(1)(B) of the Act, CMS approves a waiver or modification of the Home and Community Based Services (HCBS) Settings Requirements for HCBS services delivered through the 1915(c), 1915(k) and 1915(i) authorities, and the Medicaid Transformation Project (MTP) section 1115 demonstration authorizing these services. In order to ensure the
continuation of needed HCBS during a disaster and/or emergency, states may deliver HCBS in settings that have not been assessed for compliance with the HCBS settings criteria and may accommodate circumstances in which an individual requires relocation to an alternative setting or must modify how the settings requirements can be implemented during the emergency.
Person Centered Plan Beneficiary and Provider Signatures
Pursuant to section 1135(b)(1)(B) of the Act, CMS is granting the authority to waive or modify the requirement to obtain beneficiary and provider signatures of HCBS Person-Centered Service Plan under 42 C.F.R. § 441.301(c)(2)(ix) for 1915(c) waiver programs, 42 C.F.R. § 441.725(b)(9) for 1915(i) state plan HCBS benefit, 42 C.F.R. § 441.540(b)(9) for 1915(k) Community First Choice programs, and 1115 demonstrations, allowing states to permit documented verbal consent as an alternate to the regulatory requirement for a signature on the person-centered service plans from beneficiaries and all providers responsible for its implementation.
1915(c) Level of Care and Person-Centered Service Plan Timelines
Reevaluation
Pursuant to section 1135(b)(1)(B) of the Act, CMS is granting the authority to extend the 1915(c) HCBS Waiver Level of Care (LOC) reevaluation to allow services to continue until the reassessment can occur. All reevaluations delayed by the PHE must be completed within 12 months of the original due date. - 42 C.F.R. § 441.302(c)(2)
1915(c) Level of Care and Person-Centered Service Plan Timelines
Reevaluation for HCBS in Approved 1115 Demonstration
Pursuant to section 1135(b)(1)(B) of the Act, CMS is granting the authority to extend the 1915(c) HCBS Waiver Level of Care (LOC) reevaluation to allow services to continue until the reassessment can occur. All reevaluations delayed by the PHE must be completed within 12 months of the original due date. - 42 C.F.R. § 441.302(c)(2)
1915(c) Level of Care and Person-Centered Service Plan Timelines
Review and Revision of Person-Centered Service Plan
Pursuant to section 1135(b)(1)(B) of the Act, CMS is granting the authority to delay the review and revision of the person-centered service plan beyond 12 months. This waiver does not eliminate the requirement that the person-centered service plan be updated when the individual requests a revision and/or when the circumstances or needs of the individual change significantly. CMS also encourages states to complete these reviews and revisions of the person-centered service plan via telehealth as resources permit during the PHE. All reviews/revisions delayed by the PHE must be completed within 12 months of the original due date. - 42 C.F.R. § 441.301(c)(3)
1915(c) Level of Care and Person-Centered Service Plan Timelines
Review and Revision of Person-Centered Service Plan for HCBS in Approved 1115 Demonstration
Pursuant to section 1135(b)(1)(B) of the Act, CMS is granting the authority to delay the review and revision of the person-centered service plan beyond 12 months. This waiver does not eliminate the requirement that the person-centered service plan be updated when the individual requests a revision and/or when the circumstances or needs of the individual change significantly. CMS also encourages states to complete these reviews and revisions of the person-centered service plan via telehealth as resources permit during the PHE. All reviews/revisions delayed by the PHE must be completed within 12 months of the original due date. - 42 C.F.R. § 441.301(c)(3)
1915(i) Evaluations, Assessments and Person-Centered Service Plans
Reevaluation of 1915(i) Eligibility
Pursuant to section 1135(b)(1)(B) of the Act, CMS is granting the authority to delay the 1915(i) State Plan HCBS benefit annual required re-evaluation of 1915(i) eligibility in order to allow services to continue until the re-evaluation can occur. All reevaluations delayed by the PHE must be completed within 12 months of the original due date. - 42 C.F.R. § 441.715(e)
1915(i) Evaluations, Assessments and Person-Centered Service Plans
Reassessments of Need
Pursuant to section 1135(b)(1)(B) of the Act, CMS is granting the authority to delay the 1915(i) State Plan HCBS benefit annual required independent reassessment of need to allow services to continue until the reassessment can occur. All reevaluations delayed by the PHE must be completed within 12 months of the original due date. - 42 C.F.R. § 441.720(b)
1915(i) Evaluations, Assessments and Person-Centered Service Plans
Review and Revision of the Person-Centered Service Plan
Pursuant to section 1135(b)(1)(B) of the Act, CMS is granting the authority to delay the review and revision of the person-centered service plan beyond 12 months. CMS clarifies that this waiver does not eliminate the requirements that the person-centered plan is updated when the individual requests a revision and/or when the circumstances or needs of the individual change significantly. CMS also encourages states to complete the reviews/revisions via telehealth as resources permit during the PHE. All reviews/revisions delayed by the PHE must be completed within 12 months of the original due date. - 42 C.F.R. § 441.725(c)
1915(k) State Plan Benefit
Annual Reassessments
Pursuant to section 1135(b)(5) of the Act, CMS is granting the authority to modify the deadlines for annual reassessments of functional need. Reassessments delayed by the PHE must be completed within 12 months of the original due date. - 42 C.F.R. § 441.535(c)
1915(k) State Plan Benefit
Level of Care Redeterminations
Pursuant to section 1135(b)(5) of the Act, CMS is granting the authority to extend the timeline for the required annual Level of Care (LOC) redetermination to allow services to continue until the reassessment can occur. All redeterminations delayed by the PHE must be completed within 12 months of the original due date. - 42 C.F.R. § 441.510(c)