Florida Medicaid Waiver in Response to COVID-19 National Emergency

by admin on March 18, 2020 No comments

florida medicaid waiver for covid-19 corona virusBy David J. Davidson

On March 16, 2020, Florida became the first state to receive a Medicaid waiver from CMS in response to the COVID-19 national emergency. These provider enrollment emergency relief efforts also apply to the Children’s Health Insurance Program (CHIP), as applicable. With this waiver, Florida Medicaid, and Medicaid providers, will have greater flexibility in treating covered patients. Pursuant to the Florida waiver:


  • Florida may reimburse otherwise payable claims from out-of-state providers who are not enrolled in Florida’s Medicaid program so long as certain minimum criteria are met.
  • Medicaid will waive the limits to the number of instances of care furnished, or to how many participants received care, in a 180-day period for the duration of the emergency.
  • Florida may perform an expedited enrollment in order to accommodate participants who were displaced by the emergency, so long as a provider is enrolled in Medicare, or with another state Medicaid program.
  • With respect to providers not already enrolled, CMS will waive certain screening requirements so the state may temporarily enroll the providers.
  • Florida may temporarily stop revalidation of providers who are in Florida or are otherwise directly impacted by the emergency.
  • CMS will waive Prior Authorization Requirements.
  • CMS will waive Pre-Admission Screening and Annual Resident Review Level I and Level II Assessments for 30 Days.
  • CMS will allow evacuating facilities to provide services in alternative settings, such as temporary shelters when a provider’s facility is inaccessible.
  • Fair hearing requests and appeal deadlines that were filed between March 1, 2020 and June 29, 2020 will now be deemed to have immediately satisfied the exhaustion requirements, allowing enrollees to proceed directly to the fair hearing. Certain timeframes have also been modified and the state may delay scheduling fair hearings and issuing fair hearing decisions during the emergency.

Similar waivers are expected to be requested and received by other states, but with Florida reportedly having the fifth highest number of coronavirus cases in the country, this waiver is critical in helping to avoid administrative problems that could slow down care.

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