CMS Activates Emergency Waivers for Hawaii Healthcare Providers Six Weeks After Floods Began

Honolulu, Hawaii — The Centers for Medicare & Medicaid Services announced emergency flexibilities and resources for Hawaii healthcare providers on April 21, following a month of devastating storms, floods, landslides, and mudslides that began March 10.

HHS Secretary Robert F. Kennedy Jr. signed a Public Health Emergency declaration the same day, triggering a suite of regulatory waivers designed to keep hospitals, nursing homes, and dialysis centers operational while residents recover from the disaster.

The move comes more than a month after the initial storms hit, raising questions about the timeline between disaster and federal response.

What the Waivers Actually Do

CMS’s blanket waivers apply retroactively to March 10, covering any facility affected by the storms. Providers can request additional flexibilities through CMS’s 1135 waiver process if the standard package doesn’t fit their situation.

The agency is also activating the Kidney Community Emergency Response program through ESRD Network 17, which covers Hawaii. Dialysis patients who evacuated or lost access to their regular facilities can call a toll-free hotline at 1-800-232-3773 to find alternate care.

For nursing home residents and other Medicare beneficiaries who lost durable medical equipment, prosthetics, or medical supplies in the flooding, CMS will allow replacements without the usual documentation requirements. Beneficiaries can call 1-800-MEDICARE for help.

Part D Plans Must Cover Out-of-Network Pharmacies

Medicare Part D sponsors are required to reimburse beneficiaries for prescriptions filled at out-of-network pharmacies during the emergency period. Plans must also remove “refill too soon” edits for residents who lost medications in the floods.

The guidance follows longstanding CMS policy for disaster zones, but enforcement depends on whether plans actually follow through when beneficiaries submit claims.

Medicaid and Marketplace Enrollment Windows Open

Hawaii residents affected by the storms have up to 60 days from the end of the FEMA-designated incident period to enroll in Marketplace coverage or change their existing plans. They’ll need to contact the Marketplace Call Center at 1-800-318-2596 and explain they missed enrollment due to the disaster.

CMS also released a disaster toolkit for state Medicaid and CHIP agencies, outlining flexibilities available during emergencies to maintain coverage for vulnerable populations.

HIPAA Privacy Rules Relaxed for 72 Hours

Hospitals that activate disaster protocols can operate under relaxed HIPAA privacy rules for up to 72 hours without facing sanctions. The waiver is designed to let providers share patient information quickly during evacuations and emergency transfers.

The HHS Office for Civil Rights also issued guidance reminding first responders to provide language assistance and interpretation services during disaster response, particularly for non-English-speaking residents.

Why the Delay Matters

The storms began March 10. The PHE declaration came April 21 — more than six weeks later. While CMS applied the waivers retroactively, the gap left providers operating in a regulatory gray zone for over a month.

For nursing homes and other long-term care facilities, that means weeks of uncertainty about whether emergency staffing arrangements, expedited admissions, or supply chain workarounds would be covered under Medicare and Medicaid rules.

CMS didn’t address the timeline in its announcement, and it’s unclear whether any facilities faced enforcement actions during the interim period.

The agency says it’s continuing to work with Hawaii officials and encourages affected providers to visit CMS’s emergency webpage for updates.