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
February 18, 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 February 13, 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 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 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 February 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 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: February 18, 2026
To the extent applicable, the following waivers and modifications also apply to CHIP.
Long Term Services and Supports (LTSS)
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)