State of IL Receives Medicaid Waiver To Administer More Healthcare Services

“The Centers for Medicare and Medicaid have approved the State of Illinois’ Medicaid waiver allowing for the expansion of access to health care services. Senators Dick Durbin and Tammy Duckworth had sent a letter to CMS earlier this week asking for the waiver to be accepted so the state could administer more healthcare coverage during the COVID-19 response.

Durbin and Duckworth said in the letter that the state would be facing a surge of patients in the coming weeks because of the virus. Illinois Department of Public Health Director Dr. Ngozi Ezike yesterday said the state is trending in numbers similar to foreign countries on the number of hospitalizations caused by the virus. The acceptance of the waiver will give healthcare providers in the state more flexibility and waive restrictions on who can receive treatment and how that treatment will be paid for.

The 1135 Medicaid waiver submitted by the State of Illinois waives certain federal Medicaid, CHIP, and Health Insurance Portability and Accountability Act (HIPAA) requirements to ensure patient health care needs can be met during the COVID-19 emergency.  Specifically, the Illinois waiver request bolsters workforce capacity by waiving certain regulations on prescribing and referring practices and certain restrictions on care settings—so health providers can deliver essential care in innovative locations, such as drive-thru screening sites or by telehealth.  The waiver also suspends prior authorization requirements for most services, so patients can access necessary care without delay.

Pursuant to the March 13th national emergency declaration by President Donald Trump, CMS has the emergency authority to waive certain requirements in Medicare, Medicaid, and the Children’s Health Insurance Program under Section 1135 of the Social Security Act.

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