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
January 26, 2026
Ryan Moran, Health Care Authority Director
Trinity Wilson, Interim Medicaid Director
Washington State Health Care Authority
P. O. Box 45502
Olympia, WA 98504-5010
Re: Section 1135 Flexibilities Requested on January 12, 2026
Dear Directors Moran and Wilson:
On December 12, 2025, the President of the United States issued a proclamation declaring an emergency
in the State of Washington due to severe storms, straight-line winds, flooding, landslides, and mudslides,
with the declaration retroactive to December 9, 2025. This action was taken under the authority vested in
the President by the Constitution and federal laws, 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. On
December 23, 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 December 23, 2025, with a retroactive effective date of December 9,
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 January 12, 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 2025 State of Washington severe storms, straight-line winds, flooding, landslides, and
mudslides. 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 Washington. Please contact your state lead, Edwin Walaszek, 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: January 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.
Clinic Facility Requirement
Allow provision of clinic services via telehealth
Pursuant to section 1135(b)(1)(B) of the Act, CMS approves a waiver to permit the state and clinic to
temporarily designate a clinic practitioner’s location as part of the clinic facility only to the extent necessary
so that clinic services may be provided via telehealth when neither the patient nor practitioner is physically
onsite at the clinic. Services provided via telehealth in clinic practitioners’ homes (or another location) will
be considered to be provided at the clinic. - 42 C.F.R. § 440.90(a)