Page 3

Page 3 – Ms. Lisa Olson

the Wisconsin SeniorCare demonstration. CMS is approving this expenditure authority for the period from December 14, 2020, through and including the June 5, 2022. This approval period begins on the date that distribution of COVID-19 vaccines began in the United States and extends through and including the day before coverage for ACIP-recommended vaccinations for persons age 65 and over (including COVID-19 vaccinations) was added to the demonstration coverage for all SeniorCare demonstration enrollees (to the extent necessary). The amendment will thus ensure coverage of COVID-19 vaccinations for Wisconsin SeniorCare enrollees who lacked coverage for these vaccinations under the Medicaid state plan during part or all of this period, and who lacked other coverage for COVID-19 vaccinations that pays primary to Medicaid during part or all of this period. For persons enrolled in the demonstration who began receiving coverage for COVID-19 vaccinations under the Medicaid state plan on March 11, 2021, no coverage for COVID-19 vaccinations would be necessary or provided under this demonstration amendment beginning on that date. And, as discussed above, to the extent necessary, this expenditure authority will also apply, notwithstanding section 1903(b)(1) of the Act and implementing regulations at 42 CFR 431.625(d)(3), to state payments to providers for COVID-19 vaccine administration provided to persons who are eligible for but not enrolled in Medicare Part B. There will be no cost-sharing for the COVID-19 vaccination coverage under this amendment.

Currently, and during the effective period of this amendment, COVID-19 vaccines are federally purchased; therefore, the only expenditure authority necessary for this amendment is for payments for the administration of a COVID-19 vaccine.

This amendment will ensure COVID-19 vaccination coverage is available for the very limited number of beneficiaries who were enrolled in the demonstration, but not enrolled in other coverage that pays primary to Medicaid and that would cover the administration of COVID-19 vaccines, and who do not have coverage for COVID-19 vaccinations under the state plan. Because the expenditure authority applies notwithstanding section 1903(b)(1) of the Act and implementing regulations at 42 CFR 431.625(d)(3), it also includes coverage for COVID-19 vaccinations provided to persons who are eligible for but not enrolled in Medicare Part B. STC 40 of the Wisconsin SeniorCare demonstration, regarding payer of last resort, will apply to the coverage under this amendment. Consistent with federal law and with STC 40, the state will ensure that Medicaid is not covering a COVID-19 vaccination for a person in the demonstration if that vaccination was covered under other coverage that pays primary to Medicaid.

CMS has determined that the state’s application is complete, consistent with the exemptions and flexibilities outlined in 42 CFR 431.416(e)(2) and 431.416(g).1 CMS expects that states will offer, in good faith and in a prudent manner, a post-award public notice process, including tribal consultation as applicable, to the extent circumstances permit.

1 Pursuant to 42 CFR 431.416(g), CMS has determined that the existence of unforeseen circumstances resulting from the COVID-19 PHE warrants an exception to the normal state and federal public notice procedures to expedite a decision on a proposed COVID-19 section 1115 demonstration or amendment. States applying for a COVID-19 section 1115 demonstration or amendment are not required to conduct a public notice and input process prior to submission of the application to CMS. CMS is also exercising its discretionary authority to expedite its normal review and approval processes to render timely decisions on state applications for COVID-19 section 1115 demonstrations or amendments. CMS will post all section 1115 demonstrations or amendments approved under the COVID-19 demonstration opportunity on the Medicaid.gov website.