The Centers for Medicare & Medicaid Services (CMS) issued a memorandum on August 2 to state Medicaid directors that offers states seeking to make certain Appendix K flexibilities permanent additional administrative time to complete the process. States submitting waiver amendments for home and community-based services (HCBS) programs, including addition of flexibilities already authorized under Appendix K, prior to November 11, 2023, will be considered in compliance regardless of whether CMS has approved the waiver amendment.

States can take steps to increase slots, services, payments, or other actions already available under existing 1915(c) authorities. The new guidance should smooth the transition period for states seeking permanent flexibilities and relieve adherence to strict administrative timelines. Read the full guidance here.