ACA State Innovation Waivers
Who: Any individual in a State opting apply for and implement Section 1332 State Innovation Waivers.
When: States can apply for Section 1332 waivers in 2016 for an effective date of January 1, 2017. The Department of Health & Human Services (HHS) published a Final Rule for such waivers in 2012. On December 11, 2015, HHS and Treasury provided further guidance.
What: Section 1332 “State Innovation Waivers” of the ACA allows a state to design its own version of health reform. Many of the onerous provisions of the ACA can be waived or significantly modified to expand coverage and affordability based on each state’s unique needs and conditions.
Executive Summary: Section 1332 entitled “State Innovation Waivers” gives states an alternative to many of the burdens and restrictions of the ACA. Coverage, financing provisions, exchange options, and mandates are all potentially subject to waivers. It is even possible for subsidies that would otherwise go to individuals can be consolidated and redirected to the state to re-allocate or provide coverage to low income population under an alternative approach.
In relationship to normal requirements, ACA alternative coverage must be:
1. As comprehensive..
2. As affordable with protections against excessive cost sharing features (deductibles and co-insurance).
3. Able to provide coverage to as many or more residents.
4. Federal budget neutral over a 10 year projection period.
Examples of Areas that CANNOT be Waived or Modified
1. Pre-existing exclusions.
2. Guaranteed Issue.
3. Rating Bands.
4. Preventive Care Coverages
Section 1332 offers a tremendous opening in many of the problematic requirements of the ACA. The door is open starting January 1, 2017 to show that state laws would more effectively accomplish the ACA’s coverage, affordability, and regulatory goals.
Actions: If a state desires to create a unique state version of heath reform, elected officials must take specific steps. A 1332 waiver application must include: (1) a public hearing, (2) a public comment period, and (3) a state law granting the authorization to pursue and implement innovations once the waiver is approved. HHS and Treasury will review an application within 45 days. If complete a federal notice and public comment period will begin with a final decision no later than 180 days from application.
The information presented and contained within this article was submitted by Ronald E. Bachman, President & CEO of Healthcare Visions and Chairman of the IHC Editorial Advisory Board. This information is general information only, and does not, and is not intended to constitute legal advice. You should consult legal advisors to determine the laws and regulations applicable to your company. Any opinions expressed within this document are solely the opinion of the individual author.