CREATED BY: Policy Surveillance Program Staff

UPDATED THROUGH: July 1, 2021

While COVID-19 continues to exacerbate the ongoing opioid crisis in the United States, it has also provided an opportunity for states to adjust how opioid treatment services are delivered around the country using a variety of available mechanisms for change.

States have sought Medicaid Waivers as an emergency tool to quickly amend their existing Medicaid programs to allow for more flexibility, support, and access to services during COVID-19. Though very few states utilized Medicaid Waivers to accommodate substance use disorder treatment specifically, states used Section 1115 Waivers, Section 1135 Waivers and Section 1915(c) modifications to remove prior authorization barriers and increase the use of telehealth during the pandemic more broadly.

This dataset explores three different types of Medicaid Waivers:

• Section 1115 Waivers: Traditionally, Section 1115 waivers allow states to experiment with new approaches in Medicaid that differ from federal statute requirements and allow for more flexibility for enrollment and benefits. In response to COVID-19, the Centers for Medicare and Medicaid Services (CMS) developed a new Section 1115 demonstration opportunity for states to increase the number of available authorities and flexibilities for serving its beneficiaries during the pandemic. 
• Section 1135 Waivers: When the President has declared an emergency and the Secretary of Health and Human Services has declared a public health emergency, the Secretary can use Section 1135 authority to modify certain Medicaid requirements to assist enrollees during the emergency. Once the respective emergency and public health emergencies were declared for COVID-19, states submitted Section 1135 waivers for Medicaid provisions to CMS for approval, with the goal of ensuring the availability of health care services to meet the needs of their enrollees.
• Section 1915(c), Appendix K Modifications: Section 1915(c) typically provides most of the Medicaid home and community-based services (HCBS). Many states rely on HCBS to provide substance use treatment. States can use Appendix K, a mechanism for amending Section 1915(c), to amend Section 1915(c) Waivers to respond to an emergency. During COVID-19, states would use Appendix K to amend Section 1915(c) Waivers to allow for telehealth in HCBS.

This dataset is cross-sectional and displays key features of state Medicaid Waivers addressing COVID-19 across all 50 states and the District of Columbia approved as of July 1, 2021. The data were created with support from JCOIN grant U01DA050442 from the National Institute on Drug Abuse as part of the NIH HEAL Initiative.