Nov, 16, 2023

SHVS State Assessment Survey: Section 1902(e)(14) Waiver Flexibilities

Patti Boozang, Kinda Serafi, Kaylee O’Connor, and Michelle Savuto, Manatt Health

To support states in their efforts to unwind the Medicaid continuous coverage requirement and mitigate inappropriate loss of Medicaid and Children’s Health Insurance Program (CHIP) coverage for eligible individuals, the Centers for Medicare & Medicaid Services (CMS) has made available a number of time-limited flexibilities under section 1902(e)(14)(A) of the Social Security Act, which allows for waivers “as are necessary to ensure that states establish income and eligibility determination systems that protect beneficiaries.” States have adopted these flexibilities to address processing delays, workforce and systems limitations, and operational challenges. To date, CMS has approved 389 waivers in 49 states and Washington D.C. as part of states’ mitigation strategies to address unwinding-related challenges (see Chart 1 below for a summary of state take-up to date).

These section 1902(e)(14) waivers are intended to help states:

  • Increase ex parte[1] rates and enhance ex parte.
  • Support enrollees with renewal form submission and completion (including obtaining updated contact information).
  • Facilitate reinstatement of eligible individuals who were disenrolled for procedural reasons.


An informal and anonymous survey conducted by State Health and Value Strategies asked states to rate the value of these flexibilities during unwinding and their level of interest in making flexibilities permanent (see Chart 2 below).[2] State Health and Value Strategies received 22 survey responses and therefore findings are not representative of all states and should be interpreted with caution.

This expert perspective is intended to provide insights on the temporary section 1902(e)(14) waiver flexibilities that may be valuable for CMS to consider extending or authorizing permanently for states to take up or continue as part of streamlining and improving their post-unwinding renewal processes.

Current State Take-Up of Section 1902(e)(14) Waivers to Support Unwinding

The below chart, based on CMS data, summarizes state take-up of section 1902(e)(14) flexibilities to date.

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Illustrative Survey Results: Section 1902(e)(14) Waivers States Want to Maintain

The below chart, based on the survey conducted by State Health and Value Strategies, summarizes the section 1902(e)(14) strategies that states are most interested in maintaining as part of their permanent renewal processes, post-unwinding. Among the 22 survey respondents, there is substantial interest in making permanent flexibilities that increase ex parte rates and support enrollees with renewal processes.

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[1]Ex parte” refers to verifying eligibility based on a review of available data sources without needing to send a renewal form and request information/documentation from the enrollee.

[2] Note that CMS has not confirmed any plans to extend or authorize permanently the section 1902(e)(14) flexibilities.