Centers for Medicare & Medicaid Services
601 East 12th Street, Room 355
Kansas City, Missouri 64106-2898
Medicaid and CHIP Operations Group
June 26, 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 6, 2026
Dear Director Nichols:
On April 15, 2026, the President of the United States issued a proclamation 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 6, 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 waivers or modifications, pursuant to section 1135 of the Act, to address the
challenges posed by the 2026 Hawaii Flooding PHE. 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: June 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.
Person Centered Plan Beneficiary and Provider Signatures
Pursuant to section 1135(b)(1)(B) of the Act, CMS is granting the authority to waive or modify the
requirement to obtain beneficiary and provider signatures of HCBS Person-Centered Service Plan
under 42 C.F.R. § 441.301(c)(2)(ix) for 1915(c) waiver programs, and 1115 demonstrations,
allowing states to permit documented verbal consent as an alternate to the regulatory requirement
for a signature on the person-centered service plans from beneficiaries and all providers
responsible for its implementation.
1915(c) Level of Care and Person-Centered Service Plan Timelines
Initial Evaluation of Need
Pursuant to section 1135(b)(1)(B) of the Act, CMS is granting the authority to delay 1915(c) HCBS
Waiver Level of Care (LOC) Evaluation of Need until after the individual begins receiving services
to facilitate access to initial services. Initial evaluations of eligibility must be completed within 90
days of the PHE conclusion. - 42 C.F.R. § 441.302(c)(1)
Initial Evaluation of Need for HCBS in approved 1115 Demonstrations
Pursuant to section 1135(b)(1)(B) of the Act, CMS is granting the authority to delay 1915(c) HCBS
Waiver Level of Care (LOC) Evaluation of Need until after the individual begins receiving services
to facilitate access to initial services. Initial evaluations of eligibility must be completed within 90
days of the PHE conclusion. - 42 C.F.R. § 441.302(c)(1)
1915(c) Level of Care and Person-Centered Service Plan Timelines
Reevaluation
Review and Revision of Person-Centered Service Plan
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)
Review and Revision of Person-Centered Service Plan for HCBS in approved 1115
Demonstrations
Pursuant to section 1135(b)(1)(B) of the Act, CMS is granting the authority to delay the review and
revision of the person-centered service plan beyond 12 months. This waiver does not eliminate
the requirement that the person-centered service plan be updated when the individual requests a
revision and/or when the circumstances or needs of the individual change significantly. CMS also
encourages states to complete these reviews and revisions of the person-centered service plan
via telehealth as resources permit during the PHE. All reviews/revisions delayed by the PHE must
be completed within 12 months of the original due date. - 42 C.F.R. § 441.301(c)(3)
1915(i) Evaluations, Assessments and Person-Centered Service Plans
Reevaluation of 1915(i) Eligibility for HCBS in approved 1115 Demonstrations
Pursuant to section 1135(b)(1)(B) of the Act, CMS is granting the authority to delay the 1915(i)
State Plan HCBS benefit annual required re-evaluation of 1915(i) eligibility in order to allow
services to continue until the re-evaluation can occur. All reevaluations delayed by the PHE must
be completed within 12 months of the original due date. - 42 C.F.R. § 441.715(e)
1915(i) Evaluations, Assessments and Person-Centered Service Plans
Initial Independent Assessment of Need for HCBS in approved 1115 Demonstrations
Pursuant to section 1135(b)(1)(B) of the Act, CMS is granting the authority to delay the initial
1915(i) State Plan HCBS benefit independent assessment of need until after the individual begins
receiving services in order to facilitate access to initial services. CMS encourages states to
complete these initial assessments via telehealth as resources permit during the PHE. All initial
assessments delayed by the PHE must be completed within 90 days of the of the PHE conclusion.
- 42 C.F.R. § 441.720(a)
1915(i) Evaluations, Assessments and Person-Centered Service Plans
Reassessments of Need for HCBS in approved 1115 Demonstrations
Pursuant to section 1135(b)(1)(B) of the Act, CMS is granting the authority to delay the 1915(i)
State Plan HCBS benefit annual required independent reassessment of need 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. § 441.720(b)