Coronavirus Waivers & Flexibilities

In certain circumstances, the Secretary of the Department of Health and Human Services (HHS) using section 1135 of the Social Security Act (SSA) can temporarily modify or waive certain Medicare, Medicaid, CHIP, or HIPAA requirements, called 1135 waivers.  There are different kinds of 1135 waivers, including Medicare blanket waivers.  When there’s an emergency, sections 1135 or 1812(f) of the SSA allow us to issue blanket waivers to help beneficiaries access care.  When a blanket waiver is issued, providers don’t have to apply for an individual 1135 waiver.  When there’s an emergency, we can also offer health care providers other flexibilities to make sure Americans continue to have access to the health care they need.

Update regarding intent to end the national emergency and public health emergency declarations and extensions by way of the Consolidated Appropriations Act (CAA) for Fiscal Year 2023

Update: On Thursday, December 29, 2022, President Biden signed into law H.R. 2716, the Consolidated Appropriations Act (CAA) for Fiscal Year 2023. This legislation provides more than $1.7 trillion to fund various aspects of the federal government, including an extension of the major telehealth waivers and the Acute Hospital Care at Home (AHCaH) individual waiver that were initiated during the federal public health emergency (PHE).

Additionally, on January 30, 2023, the Biden Administration announced its intent to end the national emergency and public health emergency declarations on May 11, 2023, related to the COVID-19 pandemic.

CMS is committed to updating supporting resources and providing updates as soon as possible. Please continue to use the provider-specific fact sheets for information about COVID-19 Public Health Emergency (PHE) waivers and flexibilities.

Waivers & flexibilities for health care providers

Apply for an 1135 waiver or submit a public health emergency (PHE)-related inquiry

• Get a quick-start guide to learn how to submit an 1135 General  waiver (PDF), an 1135 Medicaid waiver (PDF), or a PHE inquiry (PDF)

• Watch our YouTube training videos:
  • 1135 Medicaid Waiver/Flexibility Requests
  • 1135 General Waiver/Flexibility Requests
  • PHE-related Inquiry Requests
• Report technical issues by email (Note “Waiver/Flexibility” in the subject line)

Learn how we’re easing burden and helping providers care for Americans by offering new waivers and flexibilities:

Read our provider-specific fact sheets for information about COVID-19 Public Health Emergency (PHE) waivers and flexibilities. These fact sheets include information about which waivers and flexibilities have already been terminated, have been made permanent, or will end at the end of the PHE.

• Physicians and Other Clinicians (PDF)
• Hospitals and CAHs (including Swing Beds, DPUs), ASCs and CMHCs (PDF)
• Teaching Hospitals, Teaching Physicians and Medical Residents  (PDF)
• Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities)  (PDF)
• Home Health Agencies   (PDF)
• Hospice (PDF)
• Inpatient Rehabilitation Facilities  (PDF)
• Long Term Care Hospitals & Extended Neoplastic Disease Care Hospitals (PDF)
• Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)  (PDF)
• Laboratories (PDF)
• Medicare Shared Savings Program (PDF)
• Durable Medical Equipment, Prosthetics, Orthotics and Supplies (PDF)
• Medicare Advantage and Part D Plans (PDF)
• Ambulances (PDF)
• End Stage Renal Disease (ESRD) Facilities (PDF)
• Participants in the Medicare Diabetes Prevention Program (PDF)
• Intermediate Care Facility for Individuals with Intellectual Disabilities (PDF)

• Waiver for Medicare Ground Ambulance Services Treatment in Place (PDF) (5/5/21)
• COVID-19 Emergency Declaration Blanket Waivers & Flexibilities for Health Care Providers (PDF) UPDATED (10/13/22)
• Blanket waivers of Section 1877(g) of the Social Security Act (3/30/20)
• Medicare and Medicaid IFC: Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (CMS-9912 IFC) (PDF) (10/28/20)
  • CMS-9912 Interim Final Rule with Comment Factsheet on Updated Policy for Maintaining Medicaid Enrollment during the Public Health Emergency for COVID-19 (10/28/20)
• Medicare and Medicaid IFC: Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (CMS-3401 IFC) (PDF) (8/25/20)
  • Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements and Revised COVID-19 Focused Survey Tool (8/26/20)
  • Interim Final Rule (IFC), CMS-3401-IFC, Updating Requirements for Reporting of SARS-CoV-2 Test Results by (CLIA) of 1988 Laboratories, and Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (8/26/20)
• Medicare and Medicaid IFC: Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (CMS-5531 IFC) (PDF) (4/30/20)
  • IFC Federal Register Announcement (5/4/20)
  • PRA Disclosure Statement (PDF) (5/21/20)
• Acute Hospital Care At Home waiver request (11/25/20)
• List of Hospital Outpatient Services and List of Partial Hospitalization Program Services Accompanying the 4/30/2020 IFC (ZIP) (4/30/20)
• Innovation Model COVID-19 Adjustments (PDF) (6/3/20)
• List of lab test codes for COVID-19, Influenza, RSV (PDF) (5/12/20)
• Medicare IFC: Revisions in Response to the COVID-19 Public Health Emergency (CMS-1744-IFC) (PDF) (3/30/20)
  • IFC Federal Register Announcement (4/1/20)
• COVID-19 Regulations & Waivers To Enable Health System Expansion (PDF) UPDATED (1/19/21)
• Graphic Overview of Flexibilities (PDF) (3/30/20)
• Frequently Asked Questions to Assist Medicare Providers (PDF) UPDATED (3/5/21)
• Provider Burden Relief Frequently Asked Questions (PDF) UPDATED (7/7/20)
• Provider Enrollment Relief Frequently Asked Questions (PDF) (3/30/20)
• Updates for State Surveyors and Accrediting Organizations (EMTALA and Infection Control) (3/30/20)
• Reprioritization of PACE, Medicare Parts C and D Program, and Risk Adjustment Data Validation (RADV) Audit Activities (HPMS Memo) (3/30/20)
• Rural Providers (PDF) (8/20/20)

1135 blanket waivers

What do I need to know about 1135 blanket waivers?

If you’re an entity in the declared emergency area, you can apply for an 1135 waiver. You’ll usually hear back from us within 2-3 days, but if your request is more complicated, it may take up to a week.  If your waiver request has 1 or 2 items, we may get back to you within 24 hours.

Once approved, waivers have a retroactive effective date of March 1, 2020 and will end no later than when the emergency declaration’s ended.

Waivers don’t offer grants or financial assistance.  They also don’t allow you to be paid for services that aren’t usually covered or for people to be eligible for Medicare who aren’t otherwise eligible.  You also shouldn’t base your response decisions, like evacuations, on waivers.  Once your waiver’s approved, as always to be reimbursed accurately, be sure to keep careful records about the services you provide and the beneficiaries you provide them to.  

1812(f) waiver

Approved Coronavirus 1812(f) waiver (PDF)

Other 1135 waivers & 1915(c) waivers

Waiver resources

• Section 1135 Waiver Checklist (3/22/20)
• Section 1915 Waiver, Appendix K Template (3/22/20)

Approved states’ other Coronavirus 1135 waivers

States’ other Coronavirus 1135 waivers

Approved states’ Coronavirus Home & Community Based (HCBS) 1915(c) Appendix K waivers

States’ Coronavirus Emergency Preparedness and Response for HCBS 1915(c) Appendix K waivers

Approved states’ 1115 demonstrations

States’ Medicaid Coronavirus 1115 demonstrations

Medicaid State Plan amendments

States’ Medicaid State Plan amendments

CHIP State Plan amendments

States’ CHIP Plan amendments

Learn more about:

• Flexibilities with 1135 waivers (PDF) 
• Flexibilities without 1135 waivers (PDF)

Find general information about waivers and flexibilities.