CMS Rescinds Medicaid 1115 Waiver Fast Track Process

In an Informational Bulletin posted on July 7, 2026, the Centers for Medicare and Medicaid Services (CMS) pulled back an informational bulletin and templates from 2015, which offered states a 'fast track' federal review process for 1115 demonstration extensions. The fast track process allowed states to submit for extensions of established demonstrations where no or minimal changes were requested with CMS reviewing and approving demonstrations in just over three months. Some demonstrations, including those addressing complex policy areas were never subject to fast track review.

Going forward, CMS states that no 1115 extensions can apply for fast track review. The bulletin cites changes to 1115 budget neutrality requirements from HR 1, and the June 11 State Medicaid Director letter (SMDL) that informed states of the new methodology for establishing budget neutrality via certification from the Chief Actuary of CMS. Recission of the fast track process is not likely to have any immediate impact on providers. View the informational bulletin here.