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
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 15, 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 15, 2026 detailed federal Medicaid requirements that pose issues or challenges for the health care delivery system in Hawaii. Below, please find a response to your request for a waiver, 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)
1915(i) Evaluations, Assessments and Person-Centered Service Plans
Review and Revision of the 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. CMS clarifies that this waiver does not eliminate the requirements that the person-centered plan is 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 the reviews/revisions 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. § 441.725(c)