SPECIAL BULLETIN COVID-19 #112: 1115 Waiver Approval and Acceptance

Friday, July 17, 2020

The Centers for Medicare & Medicaid Services (CMS) recently approved North Carolina’s Medicaid Disaster 1115 Waiver. The waiver includes several provisions that allow flexibility for long-term services and supports (LTSS) to maintain services for beneficiaries and financial relief for home and community-based service (HCBS) providers. 

  • Expedited eligibility for LTSS- allows the state to use alternative verification for LTSS eligibility to allow beneficiaries to begin to receive services while the state verifies eligibility and allows the state to delay verification and assessments of level of care.
  • LTSS- provides the state with flexibility to provide services in alternative settings such as hotels, shelters, schools, and churches during the public health emergency and in cases where the plan of care cannot be updated.
  • Retainer payments- allows the state to make retainer payments to providers who provide personal care and habilitation services, aligning with existing policies approved for beneficiaries receiving services through HCBS waivers.
  • Modified eligibility- provides the state with federal flexibility to modify eligibility for LTSS and permits the state to provide flexibilities for beneficiaries to self-attest to certain eligibility criteria. The North Carolina Department of Health and Human Services (DHHS) would work with legislative partners to determine the extent to implement any change in eligibility levels. 
  • Functional assessments- allows the state to reduce or delay functional assessments so that beneficiaries can maintain existing services during the public health emergency.

The waiver approval provides federal permission for North Carolina to implement these flexibilities and does not require implementation. DHHS is continually assessing the need for implementing available federal flexibilities and will share more information as flexibilities are implemented.

North Carolina submitted the waiver request to CMS on March 27, 2020, shortly following enactment of the Families First Coronavirus Response Act (FFCRA) but prior to the passage of the CARES Act. Since the submission of the 1115 waiver, the state has received flexibility or funding that allows North Carolinians to have access to services that were initially requested in the waiver application. Therefore, the following policies that were initially requested were no longer needed through this authority. 

  • North Carolina initially requested self-attestation for all eligibility requirements through the 1115 waiver. Since the application, the state has improved eligibility processes and have aligned with the requirements in the FFCRA to allow for self-attestation for most eligibility requirements.
  • The state initially requested authority to fast-track eligibility processes during the public health emergency. County social service workers have continued to process applications for Medicaid, despite disruptions due to the public health emergency.
  • Temporary IDs were initially envisioned to allow uninsured people who have COVID-19 the ability to seek treatment quickly however the CARES Act has provided a fund to provide testing and treatment to uninsured COVID-19 patients. 
  • North Carolina initially requested a 12-month renewal for beneficiaries. The state is already extending eligibility for existing beneficiaries during the public health emergency and requested automatically extensions to ease the eligibility process. CMS denied this request, but the state is working to reduce burden on beneficiaries and the state to maintain eligibility during the public health emergency.
  • North Carolina initially requested the ability to use Medicaid funds to pay for housing and nutrition services to vulnerable beneficiaries. North Carolina has received grants from the federal government in order to temporarily provide shelter for homeless people, fully funded by the federal government, thus using state funds through Medicaid is not required.
  • North Carolina has also received federal funding to provide food to North Carolinians with low incomes in order to maintain stay at home guidance, therefore state funds through Medicaid are not required. 

Additionally, North Carolina requested federal funds to support a Disaster Relief Fund to help Medicaid providers who have struggled with reduced service use due to stay at home orders. While the CARES Act has provided some funds for providers and NC Medicaid has directed funds to providers through a variety of ways including higher reimbursement rates, DHHS continues to work with CMS to allow North Carolina to direct funds to providers to maintain access to care for beneficiaries.  


NC Medicaid Contact Center: 888-245-0179