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
May 08, 2026
Meredith Nichols
State of Hawaii Department of Human Services
Office of the Director
PO Box 339
Honolulu, Hawaii 96809-0339
Re: Section 1135 Flexibilities Requested on May 06, 2026
Dear Acting Director Nichols:
On April 15, 2026, the President of the United States issued a proclamation retroactive to March 10, 2026,
that the 2026 Hawaii Flooding 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
21, 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 21, 2026, with a retroactive effective date of March 10, 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 May 06, 2026, detailed federal Medicaid requirements that pose issues or
challenges for the health care delivery system in Hawaii. Below, please find a response to each of your
requests for modifications, pursuant to section 1135 of the Act, to address the challenges posed by the 2026
Hawaii 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 Hawaii. 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
HAWAII
APPROVAL OF FEDERAL SECTION 1135 WAIVER REQUESTS
CMS Response: May 08, 2026
To the extent applicable, the following waivers and modifications also apply to CHIP.
Fee for Service and Eligibility Fair Hearings
Extend fair hearing request timelines
Pursuant to section 1135(b)(5) of the Act, CMS is granting the authority to modify requirements in 42
C.F.R. § 431.221(d) to allow applicants and beneficiaries to have more than 90 days to request a fair hearing
for eligibility or fee-for-service appeals by permitting extensions of the timeline to file a fair hearing request
(e.g. additional time more than 90 days). This waiver supplements the timeframe in 42 C.F.R. § 431.221(d),
which requires states to choose a reasonable timeframe for individuals to request a fair hearing not to exceed
90 days for eligibility or fee-for-service appeals.
Extend timelines for reinstatement of benefits
Pursuant to section 1135(b)(5) of the Act, CMS is granting the authority to modify requirements in 42
C.F.R. § 431.231(a) to allow states the option to reinstate services if a beneficiary requests a fair hearing
more than 10 days after the date of action (e.g., the date of termination), but not to exceed the time permitted
(under either the state plan or under an approved section 1135 waiver) for beneficiaries to request a fair
hearing. This waiver supplements the timeframe in 42 C.F.R. § 431.231(a), which gives states the option to
reinstate services and benefits for beneficiaries who request a fair hearing not more than 10 days after the
date of action. The state should reinstate the beneficiary’s services and benefits as quickly as practicable.