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
July 16, 2026
Theresa C. Arriola, MBA
Director
Department of Public Health and Social Services
155 Hesler Place
Hagatna, GU 96910
Re: Section 1135 Flexibilities Requested on July 15, 2026
Dear Director Arriola:
On April 11, 2026, the President of the United States issued a proclamation that 2026 Super Typhoon Sinlaku 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 April 17, 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 April 17, 2026, with a retroactive effective date of April 11, 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 July 15, 2026 detailed federal Medicaid requirements that pose issues or challenges for the health care delivery system in Guam. Below, please find a response to your request for a waiver, pursuant to section 1135 of the Act, to address the challenges posed by 2026 Super Typhoon Sinlaku. To the extent the requirement applies to the Children's Health Insurance Program (CHIP), Guam may apply the approved flexibility to CHIP.
We appreciate the efforts of you and your staff in responding to the needs of the residents and health care community in Guam. 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
GUAM
APPROVAL OF FEDERAL SECTION 1135 WAIVER REQUESTS
CMS Response: July 16, 2026
To the extent applicable, the following waivers and modifications also apply to CHIP.
Provider Enrollment
Pause revalidation deadlines
Pursuant to section 1135(b)(1)(B) of the Act, CMS is approving the state’s request to temporarily pause revalidation for providers located in the state or are otherwise directly impacted by the emergency.
If the state pauses revalidation for providers with revalidation due dates that fall during the PHE, the state would recalculate the provider’s revalidation due date by adding six months plus the length of the PHE to the provider’s original revalidation due date. For instance, if the provider’s revalidation due date was April 1, 2021 and the PHE lasted 12 months, the provider’s new revalidation due date would be October 1, 2022 (April 1, 2021 + six months + 12 months).