1332 State Innovation Waivers

 

Under Section 1332 of the ACA, states can apply for State Innovation Waivers (also referred to as section 1332 waivers) and pursue innovative strategies to adapt many of the law's requirements to suit the state's specific needs. To receive approval, the state must demonstrate that a proposed section 1332 waiver meets the statutory guardrails to provide coverage that is at least as comprehensive as the coverage provided without the waiver; provides coverage and cost-sharing protections against excessive out-of-pocket spending that are at least as affordable as without the waiver; provides coverage to at least a comparable number of residents as without the waiver; and does not increase the federal deficit. Before submitting its section 1332 waiver application the state must also provide a public notice and comment period, including public hearings, sufficient to ensure a meaningful level of public input, and enact a law providing for implementation of the waiver. Under a section 1332 waiver, a state may receive pass-through funding associated with the resulting reductions in federal spending on Exchange financial assistance consistent with the statute.

Active 93.423 Centers For Medicare and Medicaid Services, Department of Health and Human Services B - Project Grants Fiscal Year 2016 N/A
Fiscal Year 2017 It is expected that 4 requests and 2 awards will be made in FY17.
Fiscal Year 2018 CCIIO awarded four states (AK, HI, MN and OR) grant funds in 2018. CCIIO received five applications (ME, MD, NJ, OH, WI) in 2018 and approved four waivers (MD, MD, NJ, WI) for 2019.
Fiscal Year 2023 CCIIO awarded sixteen states (AK, CO, DE, GA, HI, ID, ME, MD, MN, MT, ND, NH, NJ, OR, PA, RI, VA, WI) grant funds in 2023. The Affordable Care Act, Section 1332 This funding opportunity is only open to US States, Territories and Possessions. N/A Written notification from HHS/CMS that a complete section 1332 waiver application package has been submitted for review. 2 CFR 200, Subpart E - Cost Principles applies to this program. Preapplication coordination is required. Pre-application coordination is strongly encouraged. 2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. N/A OMB Circular N. A-102 applies. Applicants must complete a section 1332 waiver application package information about the application process is available at https://www.cms.gov/CCIIO/Programs-and-Initiatives/State-Innovation-Waivers/Section_1332_State_Innovation_Waivers-. This package must be submitted to the 1332 e-mail box, stateinnovationwaivers@cms.hhs.gov. HHS/CMS will review the request and coordinate accordingly with the applicant. A review team will review the package and make recommendations. The final approval authority rest with the Secretary of Health and Human Services and the Secretary of the Treasury (collectively, the Secretaries). Technical assistance may be provided to any state interested in a section 1332 waiver. States should electronically submit their applications, as well as any supporting documentation or information, to the 1332 e-mail mailbox at stateinnovationwaivers@cms.hhs.gov. The Departments will render decisions on both completeness and approval; if complete, the application is posted for a Federal comment period. Not applicable. No more than 180 days from the determination of application completeness of an initial section 1332 waiver application. Not applicable. The Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond final rule (31 CFR 33.132 and 45 CFR 155.1332), as well as the state's approval letter and specific terms and conditions (STCs), include information regarding waiver extension requests. In accordance with Section 1332(e) of the ACA, waiver extension requests are deemed granted within 90 days, unless the Departments deny the request or request additional information. Not applicable. Income Security/Social Service/Welfare Income Security/Social Service/Welfare Federal pass-through funding made available through a section 1332 waiver must be used only to implement the waiver program. The amount of federal pass-through funding equals the Departments’ annual estimate of the federal financial assistance, including premium tax credits (PTC), small business tax credits, or cost-sharing reductions, provided pursuant to the ACA that would have been paid on behalf of participants in the Exchange in the state in the calendar year in the absence of the waiver, but will not be paid as a result of the waiver. Federal pass-through funding made available through Section 1332 must be used only to implement the waiver program. The pass-through funds cannot be obligated by the state prior to the waiver effective date. The state agrees to use the full amount of pass-through funding for purposes of implementing the state’s plan as approved by the Departments. To the extent any pass-through funding exceeds the amount necessary to implement the waiver program, the remaining funds must be rolled over and used for purposes of implementing the state’s plan under the waiver. If the waiver is not extended or is suspended or terminated, unused pass-through funds will be returned to the Treasury promptly, and the state will comply with all the necessary steps to do so. Federal pass-through funding made available through section 1332 must be used only to implement the waiver program. The pass-through funds cannot be obligated by the state prior to the waiver effective date. The state agrees to use the full amount of pass-through funding for purposes of implementing the state’s plan as approved by the Departments. Performance Reports: Yes – states must conduct periodic reviews and report on progress, including relevant data and metrics, as laid out in the STCs of the state’s waiver. Additionally, pursuant to 31 CFR 33.120(f) and 45 CFR 155.1320(f), at the request of the Departments), states must fully cooperate with the Departments or an independent evaluator selected by the Departments to undertake an independent evaluation of any component of the waiver. Finally, the state must participate in all monitoring calls with the Departments that the Departments deem necessary. Not applicable. The draft and final annual reports are to be published on a State's public Web site within 30 days of submission to and approval by the Secretary of Health and Human Services, respectively. Statutory formula is not applicable to this assistance listing.

Matching requirements are not applicable to this assistance listing.

This program has MOE requirements, see funding agency for further details. Additional Information: Maintenance of Effort requirements, as applicable, will be detailed in a grantee's STCs document. States will only receive federal pass-through funding assistance to which it has been calculated they are entitled in accordance with statutory and regulatory requirements, and are expected to supplement any remaining costs of the waiver program with state and/or other funding sources. The pass-through funds cannot be obligated by the state prior to the section 1332 waiver effective date. The state agrees to use the full amount of pass-through funding for purposes of implementing the state’s plan as approved by the U.S. Department of Health and Human Services (HHS) and the Department of the Treasury (collectively, the Departments). To the extent any pass-through funding exceeds the amount necessary to implement the waiver program, the remaining funds must be rolled over and used for purposes of implementing the state’s plan under the waiver. The default waiver period is five years, but waivers can be extended beyond that timeframe. If the waiver is not extended or if it is suspended or terminated, unused pass-through funds will be returned to the Treasury promptly, and the state will comply with all the necessary steps to do so. Assistance is in the form of a grant, and will be released using the Payment Management System. Method of awarding/releasing assistance: Quarterly. None/Not specified. Lina Rashid
200 Independence Ave, SW
Washington, DC 20204 US
Lina.Rashid@cms.hhs.gov
Phone: 202-260-6098 https://www.cms.gov/CCIIO/Programs-and-Initiatives/State-Innovation-Waivers/Section_1332_State_Innovation_Waivers-.html 20-0949-0-1-551 (Cooperative Agreements) FY 22$1,872,813,166.00; FY 23 est $2,849,517,625.00; FY 24 Estimate Not Available FY 21$1,741,964,536.00; FY 20$1,263,177,867.00; FY 19$939,201,611.00; FY 18$244,619,917.00; FY 17$428,864.00; FY 16$0.00; - TBD Regulations governing the application process for State Innovation Waivers can be found at 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. On October 24, 2018, the Departments published guidance (83 FR 53575, 2018 Guidance) providing information about the requirements that must be met for the approval of section 1332 waivers, including the Secretaries' application review procedures, the calculation of pass-through funding, certain analytical requirements, and operational considerations. The 2018 Guidance replaces the guidance related to Section 1332 of the ACA that was previously published on December 16, 2015 (80 FR 78131). Additionally, in November 2018, CMS released the Section 1332 State Relief and Empowerment Waiver Concepts: Discussion Paper. This paper includes four waiver concepts which are offered to spur innovative ideas that can be utilized by individual states to improve their health care markets. The four waiver concepts include: State-Specific Premium Assistance, Adjusted Plan Options, Account-Based Subsidies, and Risk Stabilization Strategies. We welcome the opportunity to work with states to take advantage of the new flexibilities provided in the guidance and to pursue section 1332 waivers incorporating these waiver concepts. On July 15, 2019, CMS also published an updated section 1332 waiver checklist to help states as they develop and complete the required elements of their applications, particularly, waiver applications for implementing high-risk pool/state-operated reinsurance programs. This updated checklist itemizes the elements required to be included in the waiver application, including specific information about the waiver concepts, and a citation to the relevant regulatory provisions. On November 6, 2020, the Departments published an interim final rule (85 FR 71142), which revises regulations to set forth flexibilities in the public notice requirements and post award public participation requirements for waivers under section 1332 during the COVID-19 PHE. On December 4, 2020 the Departments published the "Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2022 and Pharmacy Benefit Manager Standards; Updates to State Innovation Waiver (Section 1332 Waiver) Implementing Regulations" proposed rule (85 FR 78572) to codify certain policies and interpretations of the 2018 Guidance. On January 19, 2021 the Departments published the "Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2022; Updates to State Innovation Waiver (Section 1332 Waiver) Implementing Regulations" final rule (86 FR 6138) which codified many of the policies and interpretations outlined in the 2018 Guidance into section 1332 regulations. On July 1, 2021 the Departments published the "Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond Proposed Rule" proposed rule (86 FR 35156) which proposed modifications to the section 1332 waivers implementing regulations, including changes to many of the policies and interpretations of the guardrails recently codified in regulation. As outlined in the proposed rule, the policies and interpretations proposed in the rule, if finalized, would supersede and rescind those outlined in the October 2018 guidance and repeal the previous codification of the interpretations of statutory guidelines in part 1 of the 2022 Payment Notice final rule. The Departments also proposed to modify regulations to set forth flexibilities in the public notice requirements and post award public participation requirements for section 1332 waivers under certain emergent situations. The Departments also proposed processes and procedures for amendments and extensions for approved waiver plans. This proposed rule was finalized in September 2021 (86 FR 54323) and became effective on November 26, 2021. Fiscal Year 2016 N/A
Fiscal Year 2017 Alaska 1332 Waiver Program request to establish a state-re-insurance program Hawaii 1332 Waiver Program request to waive key SHOP requirements to implement the Hawaii Prepaid Healthcare Act
Fiscal Year 2018 Hawaii Small Business Health Options Program (SHOP) Waiver Program, Alaska Reinsurance Waiver Program, Minnesota Reinsurance Waiver Program, Oregon Reinsurance Waiver Program.
Fiscal Year 2023 Hawaii Small Business Health Options Program (SHOP) Waiver Program, Alaska Reinsurance Program, Minnesota Reinsurance Program, Oregon Reinsurance Program,. Maine Reinsurance Program, Maryland Reinsurance Program, New Jersey Reinsurance Program, Wisconsin Reinsurance Program, Colorado Reinsurance Program, Delaware Reinsurance Program, Montana Reinsurance Program, North Dakota Reinsurance Program, Rhode Island Reinsurance Program, Pennsylvania Reinsurance Program, New Hampshire Reinsurance Program, Georgia Reinsurance Program, Virginia Reinsurance Program, Idaho Individual High Risk Reinsurance Pool.