CMS approved COVID-19 Section 1115 waiver demonstrations in Hawaii and North Carolina. Similar to the prior approvals in Washington and New Hampshire, the new approvals are narrow in scope. In its approval letter, CMS continues to emphasize that it would prefer to use other authorities to give states flexibilities rather than Section 1115 authority. All of the expenditure authorities granted are relevant to long-term services and supports and the majority of the authorities approved are in the CMS COVID-19 1115 waiver template checklist, with limited exceptions.