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 14, 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 14, 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 27, 2026
To the extent applicable, the following waivers and modifications also apply to CHIP.
Long Term Services and Supports (LTSS)
1915(k) State Plan Benefit
Person-Centered Service Plan Reviews
Pursuant to section 1135(b)(5) of the Act, CMS is granting the authority to modify deadlines for review of the person-centered service plan beyond 12 months. CMS clarifies that this approach does not eliminate the requirements that the person-centered 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 the person-centered service plan reviews via telehealth as resources permit during the PHE. All reviews delayed by the PHE must be completed within 12 months of the original due date. - 42 C.F.R. § 441.540(c)