States' COVID-era Appendix K flexibilities would not lapse on Nov. 11, 2023, the Centers for Medicare & Medicaid Services (CMS) announced on Aug. 2, 2023. In a letter to state Medicaid directors, CMS automatically moved the expiration date to the later of Nov. 11 or the effective date of amendments that write those flexibilities into a state's 1915(c) waiver. No state action was required.
Why CMS acted
Under earlier guidance, Appendix K flexibilities were set to end six months after the public health emergency ended on May 11, 2023. Disability Scoop reported that CMS said it was uncertain whether all the waiver amendments states had submitted or planned could be approved by Nov. 11, and that the extension aimed to minimize disruption for beneficiaries, providers and states.
Advocates told Disability Scoop that states had used the flexibilities to pay family members as caregivers, add remote supports and change services and reimbursement to address staffing problems.
Why this mattered for providers and DSPs
The extension removed a hard cliff. Agencies that had relied on emergency rules, such as paying family caregivers or delivering some supports remotely, did not have to unwind them in November while states finished the paperwork to make them permanent. That gave provider groups time to press states to keep the flexibilities that had helped them cope with the DSP shortage.