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.
For additional information or to submit your application, contact the State Innovation Waiver team at stateinnovationwaivers@cms.hhs.gov.
Application, Review, and Reporting Process for Waivers for State Innovation - Opens in a new window
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.
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.
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 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.
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:
Alaska
The Departments are requesting comments on Alaska’s Section 1332 State Innovation Waiver as part of the federal public comment period. Comments can be submitted from January 17, 2017 until February 16, 2017. Please submit comments using the template below to StateInnovationWaivers@cms.hhs.gov and include Alaska Section 1332 Waiver Comments in the subject heading. Please include your name, organization (if any), and email address with the comments.
Application:
Correspondence:
California
The Departments [LR1] are requesting comments on Alaska’s Section 1332 State Innovation Waiver as part of the federal public comment period. Comments can be submitted from January 17, 2017 until February 16, 2017. Please submit comments using the template below to StateInnovationWaivers@cms.hhs.gov and include Alaska Section 1332 Waiver Comments in the subject heading. Please include your name, organization (if any), and email address with the comments.
Application:
Correspondence:
Hawai'i
On December 30, 2016, the Departments, having completed a review of Hawai’i's application, approved Hawai’i's State Innovation Waiver under section 1332 of the ACA subject to the state’s acceptance of the Specific Terms and Conditions (STCs). This approval is effective for January 1, 2017, through December 31, 2021.
Application:
Correspondence:
Vermont
Application:
Correspondence:
Under Section 1332 of the Affordable Care Act (ACA), a state can apply for a State Innovation Waiver, allowing 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. If approved, these waivers can begin on or after January 1, 2017.
The Secretary of Health and Human Services and the Secretary of the Treasury are authorized to waive a number of provisions under their respective jurisdictions. Specifically, the Secretaries are authorized to waive:
Section 1332 does not change existing waiver authority for provisions in other Federal health programs such as Medicaid or Medicare (including waiver authorities under section 3021 specific to the Center on Medicare and Medicaid Innovation or under section 1115 related to Medicaid and CHIP), although states may apply for such waivers as part of the coordinated application process to be developed by the Secretary.
States should submit their completed application in an electronic format to the Secretary of Health and Human Services at stateinnovationwaivers@cms.hhs.gov.
States should contact stateinnovationwaivers@cms.hhs.gov.
No. A state seeking a State Innovation Waiver should apply by submitting a completed application in electronic format to the Secretary of Health and Human Services at stateinnovationwaivers@cms.hhs.gov only. Upon receipt, applications will be transmitted to the Secretary of the Treasury or other relevant agencies for review as appropriate.
Prior to submitting an application, a state must provide a public notice and comment period sufficient to ensure a meaningful level of public input, including consultation with Federally-recognized Indian tribes within state borders. During the public comment period, the state must conduct public hearings to obtain public input regarding the state’s application, and must also accept written comments.
The Secretary of Health and Human Services and the Secretary of the Treasury will review an application and make a preliminary determination of whether it is complete within 45 days after it is submitted to stateinnovationwaivers@cms.hhs.gov.
After determining that the application is complete, the application will be made public through the Department of Health and Human Services website, and a federal public comment period will commence while the application is under review. A final decision regarding the waiver will be issued no later than 180 days after the preliminary determination of a complete application.
State Innovation Waivers will not be available with effective dates prior to January 1, 2017.
Regulations governing the application process for State Innovation Waivers can be found here or the Federal Register at 77 Fed. Reg. 11700 (Feb. 27, 2012). Among other things, these regulations provide guidance on how to apply for a waiver and what an application from a state must contain, including actuarial and economic analyses. The regulations detail public notice and comment requirements that a state must comply with before an application is submitted, including holding public hearings, in order to facilitate a meaningful level of public involvement, input, and transparency in the state application process. They also describe the Federal public notice and comment process that will occur after a completed application has been received. The regulations also describe the requirements for post-award reporting and the standards under which post-award monitoring will take place.
As additional questions and issues arise, the Departments of Health and Human Services and Treasury will issue further guidance.
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 regulations provide more detail about each of the application elements and should be consulted carefully as states develop applications.