Washington state petitioned the Trump administration on Tuesday for a nearly unprecedented change to its Medicaid program, tailored to respond to the state’s climbing number of COVID-19 patients.

The ask would see the state create a COVID-19 Disaster Relief Fund, allowing private philanthropists and local governments to finance much-needed emergency services targeted at getting control of the pandemic.

The move comes as Washington continues to battle the epidemic, with nearly 2,500 cases in the state and 123 deaths, almost two months after the first case appeared in the state.

The request to Centers for Medicaid & Medicare Services notes the urgency, saying that “COVID-19 now threatens the lives of millions and places extraordinary strain on Washington state’s healthcare system,” adding that “ongoing response efforts and a clear-eyed projection of what is ahead have made it clear” that the state needs the federal approval it seeks.

Jason McGill, Assistant Director for Medicaid at Washington state’s Department of Health, told TPM that the request would allow “local dollars and philanthropy dollars to pay for non-traditional Medicaid services” that the federal program currently does not cover.

That includes quarantine isolation tents, disease screening centers, and shelters for the COVID-positive homeless, among other things.

“That’s our big ask,” McGill added, saying that it remains to be seen whether the federal government would determine that “the financing makes sense, and if they have the wherewithal to approve that.”

The request was issued to CMS by asking for what is known in Medicaid parlance as a 1115 waiver, in which the federal government can approve temporary changes to its health-care programs in response to a crisis.

Washington state already petitioned the federal government with a different 1115 waiver last week, and also asked for emergency Medicaid changes under a separate waiver that was issued pursuant to President Trump’s emergency declaration.

The Trump administration partially approved that request, and Washington has come back for more in response to what it describes in the Tuesday waiver request as an “ever-escalating” crisis.

McGill told TPM that the state made the request under a template that CMS issued over the weekend as part of a bid to standardize the process through which dozens of states are asking for emergency changes to their government-run health insurance programs.

CMS approved a similar waiver in 2006, McGill said, for Louisiana following Hurricane Katrina. That program allowed the state to forego budgetary requirements to expand its Medicaid coverage in the aftermath of the hurricane.

It’s not clear what private philanthropies would contribute to the disaster relief fund, should it be approved. Money from the fund, the state says, would finance quarantine sites, the purchase of ventilators, personal protective equipment, and the establishment of a statewide tracking center to standardize and monitor COVID-19 cases.

Tierney Sneed contributed to this report.

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