Complete Information On Section 1332 Waivers

Post Date:February 10, 2018

ACA Section 1332 Waivers

Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA.

State Innovation Waivers allow states to implement innovative ways to provide access to quality health care that is at least as comprehensive and affordable as would be provided absent the waiver, provides coverage to a comparable number of residents of the state as would be provided coverage absent a waiver, and does not increase the federal deficit.

State Innovation Waivers are available beginning January 1, 2017. State Innovation Waivers are approved for five-year periods, and can be renewed. Waivers must not increase the Federal deficit.

§1332 Waiver Application Steps

About the 1332 State Innovation Waiver Application Process

States have the option to seek a State Innovation Waiver under Section 1332 of the Affordable Care Act to pursue innovative strategies to provide high quality, affordable health care coverage while retaining the statute’s basic protections. The U.S. Department of Health and Human Services (HHS) and the U.S. Department of the Treasury are responsible for reviewing waiver applications.

States may submit State Innovation Waiver applications to stateinnovationwaivers@cms.hhs.gov.

Public Input Process Prior to Submission of an Application

Prior to submitting a State Innovation Waiver application to HHS for review and consideration, a state must provide public notice and a comment period sufficient to ensure a meaningful level of public input on the application. During the public comment period, the state must conduct public hearings regarding the state’s application. In addition, a state with one or more federally recognized tribes within its borders must conduct a separate process for meaningful consultation with the tribes as part of the notice and comment process.

Application Requirements

The final regulations specify what information needs to be included in an application for a State Innovation Waiver. Critical elements of that application include (but are not limited to):

The list of provisions the state seeks to waive, including the rationale for the specific requests;
Data, assumptions, targets, and other information sufficient to determine that the proposed waiver will provide coverage that is at least as comprehensive as would be provided absent the waiver, will provide coverage and cost sharing protections that keep care at least as affordable as would be provided absent the waiver, will provide coverage to at least a comparable number of residents as would be provided coverage absent the waiver, and will not increase the Federal deficit;
Actuarial analyses and actuarial certifications to support State estimates that the waiver will comply with the comprehensive coverage requirement, the affordability requirement, and the scope of coverage requirement;
A detailed 10-year budget plan that is deficit neutral to the Federal government;
A detailed analysis of the impact of the waiver on health insurance coverage in the state;
A description and copy of the enacted state legislation providing the state authority to implement the proposed waiver; and,
A detailed plan as to how the state will implement the waiver, including a timeline.

The regulations provide more detail about each of the application elements and should be consulted carefully as states develop applications.

HHS may also request, or a state may propose, additional information to aid in the review of the application.

Application Review Process

Upon receipt of a State Innovation Waiver application, HHS and the Department of the Treasury (the Departments) will work with the state on the review and approval process. The Departments (in coordination with other agencies as applicable) will follow the process outlined below:

The Departments will conduct a preliminary review within 45 days of submission to determine if the application is complete. Written notice will be provided to the state that the preliminary determination has been made. The written notice will either indicate that the application is complete or will identify elements missing from the application.
The preliminary determination that the application was complete does not preclude a finding during the review process that a necessary element of the application is missing or insufficient.
Following the preliminary determination that a state’s application is complete, the Departments will provide for a public notice and comment period.

The final decision of the Secretaries of HHS and the Treasury will be issued no later than 180 days after the determination that an application is complete.

State Waivers of the ACA’s Private Health Insurance Rules: Key Requirements

Compiled by The Commonwealth Fund

Requirement	What Does It Mean?
1. Enrollment Waiver program must provide coverage to a comparable number of state residents as would receive coverage without it	Waiver program must cover at least as many individuals as the ACA, in every year of the program. Federal officials will consider the impact of the program on all state residents, as well as its effects across different groups of residents. This review will focus on vulnerable populations, including those with low incomes, the elderly, and those with serious health issues.
2. Affordability Waiver program must provide coverage and cost-sharing protections against excessive out-of-pocket spending that are as affordable as would be provided without it	Affordability is measured by reference to residents’ net out-of-pocket spending, including premium contributions, cost-sharing, and spending on noncovered services. Federal officials will consider both the average impact of the program and how it affects individuals with large health care spending burdens. Review also will focus on vulnerable populations.
3. Comprehensiveness Waiver program must provide coverage that is as comprehensive as would be provided without it	Waiver program must not decrease the number of individuals with coverage that satisfies the ACA’s essential health benefits requirements or the number of individuals with coverage that includes the services covered under the state’s Medicaid and CHIP programs. Federal officials will consider the impact of the program on all state residents, as well as its effects across different groups of residents. This review will focus on vulnerable populations.
4. Deficit Neutrality Waiver program must not increase the federal deficit	Waiver program must be federal deficit neutral in each year of the waiver and over a 10-year budget period. This analysis must account for the budget effect of all changes in federal income and spending resulting from the waiver, while holding the state’s Medicaid policies constant. That is, any budget effects produced by changes to the state’s Medicaid program from a Medicaid section 1115 waiver will not be considered when evaluating the 1332 waiver.

Complete Information On Section 1332 Waivers

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