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CMS Issues Guidance on Little-known State-ACA Waivers

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Michael Petruzzelli

Manager, Policy and Advocacy, National Council for Behavioral Health

CMS Issues Guidance on Little-known State-ACA Waivers

December 17, 2015 | Health Insurance Exchanges | Medicaid | Comments
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Beginning in 2017, states will have an avenue by which to fundamentally alter their methods for offering and regulating public health insurance. Section 1332 “State Innovation Waivers” were included in the Patient Protection and Affordable Care Act (ACA) to allow states the opportunity to pursue innovative methods of providing access to affordable, high quality health care while still maintaining the key elements of the ACA. However, there is growing concern over the potential scope of these waivers and their ability to significantly modify how states offer affordable insurance coverage through the marketplace.

This week, the Departments of Health and Human Services and the Treasury posted guidance on the scope of these new waivers as well as key information for states to have as they consider a waiver application.

 

What are Section 1332 Waivers?

Section 1332 waivers only apply to marketplace insurance. They do not apply to other federal health programs like Medicare or Medicaid. These five-year waivers allow states to customize requirements of federal health coverage to state and local preferences. Of particular concern is that states may attempt to utilize 1332 waivers in conjunction with Medicaid 1115 waivers to form a “super waiver” that would bring about wholesale changes to state health coverage options, affecting individuals at all levels of income. Many states have already begun laying groundwork to use the 1332 waivers in 2017.

The National Council has prepared a fact sheet for its members detailing the scope of these waivers, the coverage requirements states must maintain, and an update on state-level activities. Over the next year, the National Council will continue to monitor state activities and will report on relevant updates in the Capitol Connector.

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