A Georgia Medicaid Section 1135 waiver lets Medicaid keep paying for care during a federally declared disaster. Section 1135 of the Social Security Act (42 U.S.C. 1320b-5) authorizes the U.S. Department of Health and Human Services (HHS) to waive or modify Medicare, Medicaid, and CHIP rules during a declared emergency, so out-of-state providers can treat evacuated members, prior authorization can be suspended, and deadlines can be extended. This guide explains how those flexibilities work in Georgia, what triggers them, and what a family should do when a hurricane, ice storm, or pandemic hits.

If you are in an active emergency: call 911 first. For non-emergency help, call Georgia Medicaid Member Services at 1-866-211-0950, contact the Georgia Emergency Management and Homeland Security Agency (GEMA/HS), or dial 211 for shelter, transportation, and medication resources. For nursing home evacuation concerns, contact the Georgia Long-Term Care Ombudsman, Georgia's resident-advocacy program for long-term care.,

In This Guide

What Is a Georgia Medicaid Section 1135 Waiver?

A Georgia Medicaid Section 1135 waiver is a temporary federal authorization that lets Medicaid bend its ordinary rules during a disaster. Section 1135 of the Social Security Act, codified at 42 U.S.C. 1320b-5, authorizes the Secretary of HHS to temporarily waive or modify the requirements of Medicare, Medicaid, and CHIP for providers in an emergency area during an emergency period.

Two predicate declarations must both be in effect before the Secretary can invoke full Section 1135 authority:

  • A Presidential declaration. The President declares an emergency or major disaster under the National Emergencies Act or the Robert T. Stafford Disaster Relief and Emergency Assistance Act. For Georgia hurricanes, this declaration follows the Governor's request and GEMA/HS coordination with the Federal Emergency Management Agency (FEMA).
  • A Section 319 PHE declaration. The Secretary of HHS declares a public health emergency under Section 319 of the Public Health Service Act (42 U.S.C. 247d). A Section 319 PHE declaration terminates after 90 days, or when the Secretary declares the emergency over, whichever comes first, and the Secretary may renew it for additional periods.

For pandemics like COVID-19, both declarations were issued. For a localized event with no Presidential declaration (a Governor's state of emergency alone, for example), Section 1135 authority is not available. The Georgia Department of Community Health (DCH) may still ease some of its own requirements, but that is a state policy decision made at the time, not a federal guarantee.

A Section 1135 waiver does not last indefinitely. It ends on the earliest of three things: the underlying emergency or disaster declaration ends, the public health emergency declaration ends, or 60 days pass from the date the waiver was first published. The Secretary can extend that 60-day period by notice in further periods of up to 60 days each, but no extension can outlast either declaration. Two of the flexibilities run on a far shorter clock than that, described below.

None of this is standing authority. Nothing in Section 1135 is available on an ordinary day: it takes both declarations in effect and a waiver actually published before any of it applies.

What Section 1135 Can Waive

Once invoked, Section 1135 lets HHS, acting through the Centers for Medicare & Medicaid Services (CMS), waive or modify a defined set of requirements:

  • Conditions of participation and certification requirements for providers, including temporary modifications to nursing facility certification rules.
  • State licensure requirements, so a provider licensed in another state (for example, an Alabama physician treating Georgia evacuees) can deliver and bill for Medicaid services. The statute attaches two conditions: the professional must hold an equivalent license in the other state and must not be affirmatively excluded from practice there.
  • Pre-approval and prior authorization requirements for services such as hospital admissions, skilled nursing facility admissions, home health, and durable medical equipment.
  • Deadlines and timetables for fair hearings, redeterminations, and similar procedural matters. The statute is precise here: deadlines may be modified, not waived. A disaster can push a due date back so members are not penalized, but it does not make the requirement disappear.
  • Actions under the Emergency Medical Treatment and Labor Act (EMTALA) for emergency transfers and relocations, and sanctions under the physician self-referral (Stark) law. The statute's word for the EMTALA paragraph is "actions," not "sanctions," and it is what lets a hospital move or redirect a patient during a disaster.

Two of those flexibilities run on a much shorter clock than the 60-day outer limit above, and this is the detail most often reported wrong. A waiver of EMTALA, and a waiver of the HIPAA privacy requirements, is limited to a 72-hour period beginning when the hospital implements its disaster protocol, except where the public health emergency involves a pandemic infectious disease. So the 60 days is the ceiling for the other flexibilities; for these two, assume 72 hours unless a pandemic is the declared emergency.

Other federal authorities work alongside Section 1135, including Section 1812(f) of the Social Security Act for Medicare skilled nursing facility coverage and Section 1115 demonstration authority for states that already operate a demonstration. CMS issues the request templates Georgia uses and, in large events, can issue blanket waivers that apply to every state at once.

What about telehealth?

In Medicaid, telehealth is a mode of delivering covered services that a state may choose to use, not a distinct federally mandated benefit. CMS says that for most Medicaid benefits, federal Medicaid law and regulations do not address telehealth delivery methods, so each state sets its own telehealth parameters through its CMS-approved state plan and program rules. That flexibility is not unlimited: where Medicaid law or regulations do set telehealth requirements for a specific benefit (for example, the assessment of need under the Community First Choice option at 42 CFR 441.535), those requirements still apply. Because Georgia sets its own telehealth parameters, what telehealth covers during an emergency is a Georgia question with a changing answer. The COVID-era expansions were temporary, so confirm current coverage with DCH or your plan.

What about my prescriptions?

Federal law builds in a pharmacy safety net that matters in a disaster. When a state Medicaid program requires prior authorization before dispensing a covered outpatient drug, Social Security Act Section 1927(d)(5) (42 U.S.C. 1396r-8(d)(5)) requires the system to respond to a prior authorization request within 24 hours and to dispense at least a 72-hour emergency supply of a covered drug in an emergency. Early refills and out-of-state pharmacy fills for displaced members are a state-level allowance, not a federal right, so ask your plan or DCH whether one is in effect.

HCBS Appendix K: Flexibility for Home Care Waivers

Home and Community-Based Services (HCBS) waivers are authorized by Section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)), which lets a state cover home or community-based care for people who would otherwise need an institutional level of care. For these waivers, CMS uses a standardized template called Appendix K to modify the rules during an emergency. What follows is what the template lets a state request, not what is approved in Georgia today. An approved Appendix K amendment can let a state:

  • Add settings where services may be delivered, such as shelters, hotels, or the homes of relatives.
  • Pay family caregivers for services that would otherwise be unpaid, which is critical when a professional caregiver cannot reach a displaced member.
  • Extend level-of-care reassessment and person-centered planning timelines.
  • Temporarily modify provider qualifications and authorize remote service delivery.
  • Authorize short-term facility-based respite when a family caregiver is displaced.

Appendix K amendments are time-limited, lasting through the emergency plus a wind-down period, so none is in force on an ordinary day. Georgia operates four Section 1915(c) HCBS waivers: the Elderly and Disabled Waiver Program (EDWP) for elderly and physically disabled adults, which delivers its services through two models, the Community Care Services Program (CCSP) and Service Options Using Resources in a Community Environment (SOURCE); the Independent Care Waiver Program (ICWP) for adults with severe physical disabilities; and the New Options Waiver (NOW) and Comprehensive Supports Waiver (COMP) for people with intellectual and developmental disabilities. Whether an Appendix K amendment covers any of them right now is published by CMS, so ask your case manager rather than assuming a COVID-era provision survived.

What COVID-19 Taught Georgia Medicaid

The COVID-19 public health emergency was the longest test the Section 1135 framework has faced, and it reshaped how Georgia prepares for disasters. CMS leaned heavily on blanket waivers that applied to every state at once, with state-specific approvals and Appendix K amendments layered on top. All of it has since expired.

Two laws carried the most weight for Medicaid members. Section 6008 of the Families First Coronavirus Response Act (FFCRA, Public Law 116-127, enacted March 18, 2020) gave states a temporary 6.2 percentage-point increase in their federal medical assistance percentage (FMAP), on the condition that they keep enrolled members continuously covered through the end of the emergency period. That condition effectively suspended Medicaid disenrollment for years.

Section 5131 of the Consolidated Appropriations Act, 2023 (CAA 2023, Public Law 117-328, enacted December 29, 2022) then ended that continuous-enrollment condition on March 31, 2023, separate from when the PHE itself ended. Beginning April 1, 2023, states resumed checking eligibility, a process called "unwinding," and CMS gave states up to 12 months to start and 14 months to finish a renewal for everyone enrolled during the PHE. That schedule is why Georgia members were asked to renew across 2023 and 2024, and why a missed notice could end coverage for someone who still qualified.

The lasting lessons: continuous enrollment prevents coverage churn, Appendix K keeps home care running, and clear member communication matters as much as any waiver.

When Has Georgia Used a Medicaid Section 1135 Waiver?

Which flexibilities CMS actually approved for a given storm is public record: CMS publishes approved Section 1135 waivers by state, and DCH posts its own provider notices. Start there rather than with a list. What is certain is that none of them survives, because a Section 1135 waiver terminates when its disaster declaration ends, when its public health emergency declaration ends, or 60 days after it was first published, whichever comes first. Every flexibility tied to the events below has ended.

  • Hurricane Matthew (October 2016). Coastal counties evacuated.
  • Hurricane Irma (September 2017). The storm crossed the full state, and Georgia absorbed a large evacuation from Florida.
  • Hurricane Michael (October 2018). Michael made a Category 5 landfall in the Florida Panhandle but had weakened to a Category 3 hurricane when its eye crossed into southwest Georgia near Seminole County, the first major hurricane to directly strike Georgia since the 1890s. Albany and the surrounding agricultural region suffered severe, prolonged damage.
  • COVID-19 PHE (March 2020 through May 2023). The longest emergency period the program has run, and the one that produced the widest use of Section 1135 and Appendix K nationwide.
  • Hurricane Idalia (August 2023). Affected south Georgia.
  • Hurricane Helene (September 2024). Caused widespread damage well inland, including in counties not historically hit by hurricanes; recovery extended into 2025.

Georgia also faces recurring north Georgia ice storms, tornado outbreaks (including the 2021 Newnan tornado), wildfires, and flooding. Smaller events may not trigger a federal declaration at all, which leaves any easing of the rules to DCH's own discretion at the time.

Who Runs Georgia's Emergency Response?

Several agencies share the work during a Georgia emergency.

Georgia Emergency Management and Homeland Security Agency (GEMA/HS) Coordinates the state disaster response and is the primary liaison to FEMA.
Georgia Department of Community Health (DCH) Runs Georgia Medicaid; coordinates Section 1135 requests with CMS, directs the managed care plans, and handles member outreach and continuity of eligibility. dch.georgia.gov
Georgia Department of Public Health (DPH) Runs the Public Health Emergency Operations Center and leads the response to pandemics and other public health threats. dph.georgia.gov
Georgia Medicaid managed care plans Amerigroup, Peach State Health Plan, and CareSource carry out approved flexibilities for their members. Under federal managed care rules at 42 CFR 438.114, a plan must cover emergency services regardless of whether the provider is in network and without prior authorization.
Georgia Long-Term Care Ombudsman Advocates for nursing home and assisted living residents during evacuations; run by the Georgia Department of Human Services Division of Aging Services. aging.georgia.gov/programs-and-services/long-term-care-ombudsman-program

Local emergency management agencies in each county coordinate evacuation and shelter operations on the ground.

How a Section 1135 Waiver Works, Step by Step

The Section 1135 process moves fast during an emergency. The typical sequence:

1
Step 1

Predicate declarations

A Presidential emergency or disaster declaration and a Section 319 PHE declaration must both be in effect. For a Georgia hurricane, the Presidential declaration follows the Governor's declaration and request to the President.

2
Step 2

State request to CMS

DCH submits Section 1135 waiver requests to CMS Region IV in Atlanta using CMS templates, specifying which flexibilities Georgia needs.

3
Step 3

CMS approval

CMS typically approves within days during an active emergency and publishes approved waivers on its website. In large events, CMS may issue blanket waivers covering all states.

4
Step 4

Implementation

DCH communicates the approved flexibilities to managed care plans, hospitals, nursing facilities, HCBS providers, pharmacies, and members (through 211, media, and direct outreach).

5
Step 5

Operations and wind-down

Providers deliver care under the modified rules; when the emergency ends, the flexibilities terminate on a schedule, though a state may separately choose to write one of them into its ordinary rules afterward.

What Families Should Do Before and During an Emergency

Planning ahead is what makes these flexibilities work for a real family.

  • Keep proof of coverage accessible. Have the Medicaid card (digital or physical) available; DCH can verify eligibility electronically through Georgia Gateway if the card is lost.
  • Build a medication kit. Keep a 30-day supply where possible, plus a written list of medications, doses, and prescribers, and know your mail-order pharmacy options. Where Georgia Medicaid requires prior authorization for a drug, federal law requires that system to allow at least a 72-hour emergency supply.
  • Plan HCBS contingencies. Ask your case manager about the waiver's emergency protocol and whether Appendix K paid-family-caregiver provisions could apply if a professional caregiver cannot reach you. The Georgia Aging and Disability Resource Connection (ADRC) (1-866-552-4464) can help.
  • Know nursing home evacuation rights. Federal rules at 42 CFR 483.15 govern transfer and discharge from a nursing facility, including written notice to the resident and the resident's representative with a copy to the State Long-Term Care Ombudsman. Track where your loved one is, confirm the receiving facility can meet care needs, ensure medication continuity, and engage the Georgia Long-Term Care Ombudsman if problems arise.
  • Plan for dialysis and power-dependent equipment. End-stage renal disease patients should register with their dialysis facility for emergency notification; in Georgia, dialysis emergency response is coordinated by ESRD Network 6, the Southeastern Kidney Council, which serves Georgia, North Carolina, and South Carolina. Members who depend on oxygen, ventilators, or other powered equipment should enroll in their utility's special-needs program and arrange backup power.
  • Save the right numbers. Dial 211 for shelter, food, transportation, and medication help; Georgia Medicaid Member Services is 1-866-211-0950. GEMA/HS and Disability Rights Georgia publish current contact details online.

How Flexibilities Wind Down

Every emergency has a wind-down after the formal declaration ends. Provider enrollment flexibilities phase out (often with protections for care already in progress), prior authorization and level-of-care reassessment requirements resume, fair hearing deadlines return, and Appendix K provisions end on a phased transition. A state may afterward write one of those flexibilities into its ordinary rules, but that is a fresh policy decision, not the waiver continuing. The COVID-19 wind-down ran through 2023 and 2024 under the CAA 2023 framework. Respond promptly to any renewal notice.

Worked Examples

These are illustrative scenarios, not real individuals, showing how disaster flexibilities operate in practice.

A nursing home resident evacuated by hurricane

A resident at a coastal Brunswick nursing home is evacuated inland when a mandatory evacuation order is issued for Glynn County. She is placed at a facility that does not have her on its census but has an open bed. Under Section 1135 provider flexibility, the receiving facility is authorized to provide and bill for her care, and the family asks the Brunswick facility how long its Georgia Medicaid bed-hold runs. The Long-Term Care Ombudsman contacts them to confirm continuity. After the storm, she returns to Brunswick, having kept continuous Medicaid coverage throughout.

A dialysis patient during a north Georgia ice storm

A patient with end-stage renal disease who receives in-center hemodialysis three times a week loses access to his usual clinic when an ice storm knocks out power across north Georgia. ESRD Network 6 activates emergency protocols, and he is referred to a facility with power. Under Section 1135 provider flexibility, Medicaid covers dialysis at the alternative facility even though it is not his usual provider, and the facility verifies his coverage through Georgia Gateway. He returns to his regular clinic once power is restored.

A displaced member who needs emergency care out of network

A pregnant member evacuates from Savannah to Atlanta ahead of a hurricane and goes into labor at a hospital outside her managed care plan's local network. Her plan must cover those emergency services regardless of whether the hospital is in its network, and without prior authorization. She and her newborn are covered throughout, and her care transfers back to Savannah after the storm.

A home care client cut off by a localized emergency

A rural member who receives twice-weekly home health visits is cut off when an ice storm closes local roads for several days, and her agency cannot reach her. Even without a formal Section 1135 declaration for the localized event, DCH may allow extended visit scheduling and telehealth supervision so her family caregiver can perform basic care until the agency resumes in-person visits. Only where an Appendix K amendment is actually in effect could that family caregiver also be paid for the interim care.

Frequently Asked Questions

What is a Georgia Medicaid Section 1135 waiver?

It is a temporary federal authorization, under Section 1135 of the Social Security Act (42 U.S.C. 1320b-5), that lets HHS waive or modify Medicare, Medicaid, and CHIP requirements during a declared emergency so Georgia Medicaid can keep paying for care. Common flexibilities include out-of-state provider enrollment, prior authorization suspension, telehealth expansion, and extended deadlines.

When does Section 1135 apply in Georgia?

Two declarations must both be in effect: a Presidential emergency or major disaster declaration and a Section 319 public health emergency declaration by the Secretary of HHS. A Section 319 PHE declaration lasts 90 days and can be renewed. A localized event with no Presidential declaration does not trigger Section 1135 authority, though DCH may still ease some of its own requirements.

My family member is being evacuated from a nursing home. What protections apply?

Federal transfer and discharge protections at 42 CFR 483.15 still apply. The facility may transfer or discharge a resident only for the limited reasons the rule lists, and it must give written notice of the transfer and its reasons to the resident and the resident's representative, with a copy to the State Long-Term Care Ombudsman. Whether the bed is held for a return is a separate Georgia Medicaid bed-hold question to put to the facility. Contact the Georgia Long-Term Care Ombudsman for help.

My doctor or pharmacy is unavailable during a disaster. Can I still get care and prescriptions?

Yes. Section 1135 provider flexibility lets out-of-state providers deliver Medicaid services, and your managed care plan must cover emergency services whether or not the provider is in its network, without prior authorization. For medications, where Georgia Medicaid requires prior authorization for a drug, federal law requires that system to allow at least a 72-hour emergency supply. Early refills and out-of-state fills are a state-level allowance, so ask your plan.

What happens to my Medicaid coverage if I am displaced for weeks?

Displacement by itself does not end your eligibility, and Section 1135 lets the state modify (though not waive) renewal and fair hearing deadlines so a missed date is not held against you. The COVID-era rule that kept everyone continuously enrolled ended on March 31, 2023, so keep your contact information current and answer any renewal notice.

How do I prepare my family for an emergency?

Keep a 30-day medication supply and a written medication list, keep your Medicaid card accessible, register power-dependent equipment with your utility's special-needs program, know your shelter options, and save key numbers: dial 211 for resources, and the Georgia Aging and Disability Resource Connection at 1-866-552-4464.

Learn More

MedicaidGeorgia Emergency MedicaidGeorgia Emergency Medicaid pays for emergency care, including labor and delivery, for non-citizens who meet every Medicaid rule except immigration status. MedicaidGeorgia Medicaid HCBS WaiversGeorgia's four Medicaid HCBS waivers in 2026: who EDWP (CCSP and SOURCE), ICWP, NOW, and COMP serve, the 300% SSI limit, the planning list, and how to apply. MedicaidGeorgia Medicaid Long-Term CareGeorgia Medicaid long-term care in 2026: nursing facility coverage, four HCBS waivers (EDWP with CCSP and SOURCE, ICWP, NOW, COMP), PACE, and how to apply. MedicaidGeorgia Medicaid Managed Care PlansGeorgia Medicaid managed care in 2026: the three Georgia Families CMOs (Amerigroup, CareSource, Peach State), how to choose a plan, and how to switch. MedicaidGeorgia Medicaid Appeals and Fair HearingsHow to appeal a Georgia Medicaid denial, reduction, or termination, keep your benefits during the appeal, exhaust an MCO appeal, and reach an OSAH hearing. MedicaidGeorgia Medicaid Redetermination and UnwindingGeorgia's 2023-2024 Medicaid unwinding ended coverage for over 802,000 people. What happened, the figures it posted, and how to get reinstated.

Find personalized help navigating Georgia Medicaid emergency flexibilities at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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