Department of Health & Human Services
Centers for Medicare & Medicaid Services
601 East 12th Street, Room 355
Kansas City, Missouri 64106-2898
August 5, 2025
Emily Zalkovsky
State Medicaid Director
Texas Health and Human Services Commission
P.O. Box 13247
Austin, TX 78711-3247
Re: Section 1135 Flexibilities Requested on July 24, 2025
Dear State Medicaid Director Emily Zalkovsky:
On July 6, 2025, the President of the United States issued a proclamation that 2025 Texas Flooding, retroactive to July 2, 2025, 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 July 8, 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 July 8, 2025, with a retroactive effective date of July 2, 2025. 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 24, 2025 detailed federal Medicaid requirements that pose issues or challenges for the health care delivery system in Texas. 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 2025 Texas Severe Storms, Straight-Line Winds, and Flooding. 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 Texas. Please contact your state lead if you have any questions or need additional information.
Sincerely,
Courtney Miller
Director
cc: Anne Marie Costello
Courtney Miller
Caprice Knapp
STATE OF TEXAS
APPROVAL OF FEDERAL SECTION 1135 WAIVER REQUESTS
CMS Response: August 05, 2025
To the extent applicable, the following waivers and modifications also apply to CHIP.
Managed Care Appeals, Fair Hearings, and Continuation of Benefits
Modify continuation of benefits timelines
Pursuant to section 1135(b)(5) of the Act, CMS is granting the authority to modify timeframes at 42 C.F.R. § 438.420(a)(i) through the end of the PHE. The modified timeframes will allow the managed care plan to continue benefits if requested within the current 10-day timeframe or reinstate benefits when the individual requests continuation of benefits between 11 and 30 days after receiving notice if the managed care plan has not yet made a decision on the appeal or the state fair hearing is pending. This flexibility may be used provided that the managed care plan may not seek reimbursement or payment for the additional days of services furnished during this period (aside from otherwise applicable cost sharing, if any) from the enrollee.
Modify standard appeals timelines
Pursuant to section 1135(b)(5) of the Act, CMS is granting the authority to modify timeframes in 42 C.F.R. § 438.408(c)(1)(ii) for standard appeals from 14 days to 30 days. This modification allows the managed care plan additional time to obtain necessary information, if the delay is in the enrollee’s interest such as to gather information necessary for a decision that is favorable to the enrollee; the managed care plan must continue to authorize and pay for the service(s) until a decision is made and may not seek reimbursement or payment for the services furnished during this additional period (aside from otherwise applicable cost sharing, if any) from the enrollee in the event of an adverse decision. For example, insufficient information within the 14-day time period could lead a decision to deny the service authorization. During the extension period of up to 30 days, the managed care plan will authorize and pay for the services based on the information available until the assessment can be completed.
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).