- State Specific Premium Assistance Waiver Concept (PDF)
- State Specific Premium Assistance Waiver Application Template (DOCX)
- Adjusted Plan Options Waiver Application Template (DOCX)
- Account-Based Subsidies Waiver Application Template (DOCX)
- Risk Stabilization Strategies Waiver Application Template (DOCX)
Pass-through Funding Tools and Resources
- Frequently Asked Questions (FAQs)
- February 28, 2019 -Section 1332 State Relief and Empowerment Waiver Pass-through Funding Frequently Asked Questions (FAQs) (PDF)
- April 21, 2021 –Section 1332 Waiver Frequently Asked Question (FAQ) on the American Rescue Plan and Pass-through Funding (PDF)
- February 28, 2019 -2019 U.S. Department of the Treasury Method for Calculation of Section 1332 Waiver Premium Tax Credit Pass-through Amounts (PDF)
- February 28, 2019 -Key Components of PPACA Section 1332 Tentative Pass-through Payments Reinsurance Waivers, 2019 (XLSX)
- February 28, 2019 -Advance Payments of the Premium Tax Credit (APTC) by State and Rating Area January through June, 2018 (XLSX)
- February 28, 2019 -State Specific Premium Data for Section 1332 Waiver 2019 Pass-through Calculations (XLS)
- April 3, 2020 –2020 U.S. Department of the Treasury Method for Calculation of Section 1332 Waiver Premium Tax Credit Pass-through Amounts (PDF)
- January 10, 2020 –2020 U.S. Department of the Treasury Method for Calculation of Section 1332 Waiver Premium Tax Credit Pass-through Amounts for Maryland (PDF)
- April 3, 2020 -Key Components of PPACA Section 1332 Tentative Pass-through Payments Reinsurance Waivers, 2020 (XLSX)
- January 10, 2020 -Advance Payments of the Premium Tax Credit (APTC) by State and Rating Area January through June, 2020 (XLSX) (XLSX)
- April 3, 2020 -State Specific Premium Data for Section 1332 Waiver 2020 Pass-through Calculations (XLSX)
- November 6, 2020 –2021 U.S. Department of Treasury Update on Method for Calculation of Section 1332 Reinsurance Waiver 2021 Premium Tax Credit Pass-through Amounts (PDF)
- March 11, 2021 –2021 U.S. Department of the Treasury Method for Calculation of Section 1332 Waiver Premium Tax Credit Pass-through Amounts (PDF)
- February 25, 2021 –2021 U.S. Department of the Treasury Method for Calculation of Section 1332 Waiver Premium Tax Credit Pass-through Amounts (PDF)
- February 25, 2021 –Key Components of PPACA Section 1332 Tentative Pass-through Payments Reinsurance Waivers, 2021 (XLSX)
- February 25, 2021 –Advance Payments of the Premium Tax Credit (APTC) by State and Rating Area, January through December, 2020 (XLSX)
- February 25, 2021 –State Specific Premium Data for Section 1332 Waiver 2021 Pass-through Calculations (XLSX)
- September 7, 2021 –2021 U.S. Department of the Treasury Update of Section 1332 Reinsurance Waiver Premium Tax Credit Pass-through Amounts: Methodology for Adjustment for the American Rescue Plan (PDF)
- November 3, 2021 –Key Components of ACA Section 1332 Pass-through Payments Reinsurance Waivers, 2021 Update for American Rescue Plan (XLSX)
- November 3, 2021 -2021 U.S. Department of the Treasury Method for Calculation of Section 1332 Waiver Premium Tax Credit Pass-through Amount for New Jersey (with addendum) (PDF)
- March 24, 2022 - 2022 U.S. Department of the Treasury Method for calculation of Section 1332 Waiver Premium Tax Credit Pass-through Amounts (PDF)
- March 24, 2022 - Key Components of ACA Section 1332 Tentative Pass-through Payments Reinsurance Waivers, 2022 (XLSX)
- March 24, 2022 -State Specific Premium Data for Section 1332 Waiver 2022 Pass-through Calculations (XLSX)
- May 18, 2022 - Key Components of ACA Section 1332 Pass-through Payments Reinsurance Waivers, 2022 Updated (XLSX)
- March 30, 2023 – 2023 U.S. Department of the Treasury Method for Calculation of Section 1332 Waiver Premium Tax Credit Pass-through Amounts (PDF)
- May 30, 2023 – Key Components of ACA Section 1332 Tentative Pass-through Payments Reinsurance Waivers, 2023 (XLSX)
- August 30, 2023 – State Specific Premium Data for Section 1332 Waiver 2023 Pass-through Calculations (XLSX)
- August 30, 2023 – Key Components of ACA Section 1332 Pass-through Payments Reinsurance Waivers, 2023 (XLSX)
- May 2, 2024 – 2024 U.S. Department of the Treasury Method for Calculation of Section 1332 Waiver Premium Tax Credit Pass-through Amounts (PDF)
- May 2, 2024 – Key Components of ACA Section 1332 Tentative Pass-through Payments Reinsurance Waivers, 2024 (XLSX)
- September 3, 2024 – State Specific Premium Data for Section 1332 Waiver 2024 Pass-through Calculations (XLS)
- September 3, 2024 – Key Components of ACA Section 1332 Pass-through Payments Reinsurance Waivers, 2024 (XLSX)
- September 5, 2024 – 2024 U.S. Department of the Treasury Method for Calculation of Section 1332 Basic Health Program “Lookalike” Waiver Premium Tax Credit Pass-through Amounts (PDF)
- September 5, 2024 – Key Components of New York’s ACA Section 1332 Pass-through Payment, 2024 (XLSX)
- May 9, 2019 -2018 User Fee Data (XLSX)
- July 9, 2020 -2019 User Fee Data (XLSX)
- August 13, 2021 -2020 User Fee Data (XLSX)
- February 2, 2024 -2021 and 2022 User Fee Data -Medical, Dental, Totals (XLSX)
- September 20, 2019 - 2019 Budget Midsession Review Estimates(Tables 1-3, Types of Coverage, ESI, and PTC, 2019)
The Office of Tax Analysis (OTA) maintains a tax microsimulation model that represents the U.S. population and simulates income and payroll taxes, including the PTC, over a ten-year budget period. OTA projections for the Budget period are generally made using the Administration’s macroeconomic assumptions prepared for the annual Budget or midsession review. This includes the 2019 Budget mid-session review estimates that were used for the 2019 pass-through calculations. States can use this as a resource for their 1332 waivers. - September 20, 2020 - 2020 Budget Midsession Review Estimates(Tables 1-3, Types of Coverage, ESI, and PTC, 2020)
The Office of Tax Analysis (OTA) maintains a tax microsimulation model that represents the U.S. population and simulates income and payroll taxes, including the PTC, over a ten-year budget period. OTA projections for the Budget period are generally made using the Administration’s macroeconomic assumptions prepared for the annual Budget or midsession review. This includes the 2020 Budget mid-session review estimates that will be used for the 2020 pass-through calculations. States can use this as a resource for their 1332 waivers.
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.
Section 1332 State Innovation Waiver Applications
Alaska
On July 17, 2017, the Departments, having completed a review of Alaska’s application, approved Alaska’s State Innovation Waiver under section 1332 of the ACA. On July 31, the state accepted the Specific Terms and Conditions (STCs). This approval is effective for January 1, 2018, through December 31, 2022.
On July 13, 2022, the Departments, having completed a review of Alaska's waiver extension application submitted on March 17, 2022, approved Alaska's waiver extension request under section 1332 of the ACA. This approval is effective for January 1, 2023 through December 31, 2027.
Initial Waiver (2017)
Application:
- Alaska Section 1332 State Innovation Waiver- Opens in a new window
- Public Comment on Waiver during Federal Comment Period (PDF)
- Fact Sheet (PDF)
Correspondence:
- Alaska Approval letter and signed STC (PDF)
- Alaska Notice of Preliminary Determination of Completeness (PDF)
- Letter from Secretary Burwell to Governor Walker on Section 1332 State Innovation Waiver Application (PDF)
Waiver Extension Request (2022)
Application:
- Alaska Section 1332 State Innovation Waiver: Extension Application
- Public Comments on Waiver Extension during Federal Comment Period (PDF)
- Response to Public Comments on Waiver Extension during Federal Comment Period (PDF)
- Fact Sheet: Waiver Extension (PDF)
Correspondence:
- Alaska's Letter of Intent to Apply for a Waiver Extension and Response (PDF)
- Notice of Preliminary Determination of Completeness for Extension Application (PDF)
- Alaska Waiver Extension Approval Letter and STCs (PDF)
Pass-through funding:
- Alaska Pass Through Funding for the 2018 Year (PDF)
- Alaska Pass Through Funding for the 2019 Year (PDF)
- Alaska Pass Through Funding for the 2020 Year (PDF)
- Alaska Pass Through Funding for the 2021 Year (including adjustments for ARP) (PDF)
- Alaska Pass Through Funding for the 2022 Year (PDF)
- Alaska Pass Through Funding for the 2023 Year (PDF)
- Alaska Pass Through Funding for the 2024 Year (PDF)
California
Application:
Correspondence:
- California Notice of Preliminary Determination of Completeness (PDF)
- California Notice of Preliminary Determination of Incompleteness (PDF)
- California Letter to Withdraw 1332 State Innovation Waiver (PDF)
Colorado
On July 31, 2019, the Departments, having completed a review of Colorado's application, approved Colorado's State Innovation Waiver under section 1332 of the ACA. This approval is effective for January 1, 2020 through December 31, 2021
On August 13, 2021, the Departments, having completed a review of Colorado’s waiver extension application submitted on April 30, 2021, approved Colorado’s 5-year extension request under section 1332 of the ACA. This approval is effective for January 1, 2022 through December 31, 2026.
On June 22, 2022, the Departments, having completed a review of Colorado's waiver amendment application submitted on November 30, 2021, approved Colorado's waiver amendment request under section 1332 of the ACA. This approval is effective for January 1, 2023 through December 31, 2027.
Initial Waiver (2019)
Application:
- Colorado Section 1332 State Innovation Waiver
- Public Comments on Waiver during the Federal Comment Period (PDF)
- Response to Public Comments on Waiver during Federal Comment Period (PDF)
- Fact Sheet (PDF)
Correspondence:
- Notice of Preliminary Determination of Completeness (PDF)
- Colorado Approval Letter and STCs (PDF)
Waiver Extension Request (2021)
Application:
- Colorado Section 1332 State Innovation Waiver: Extension Application
- Public Comments on Waiver Extension during Federal Comment Period (PDF)
- Response to Public Comments on Waiver Extension during Federal Comment Period (PDF)
- Fact Sheet: Waiver Extension (PDF)
Correspondence:
- Colorado’s Letter of Intent to Apply for a Waiver Extension and Response (PDF)
- Notice of Preliminary Determination of Completeness for Extension Application (PDF)
- Colorado Extension Approval Letter and STCs (PDF)
Waiver Amendment Request (2021)
Application:
- Colorado Section 1332 State Innovation Waiver: Amendment Application
- Public Comments on Waiver Amendment during Federal Comment Period (PDF)
- Public Comments from Organizations on Waiver Amendment during Federal Comment Period (PDF)
- Fact Sheet: Waiver Amendment (PDF)
- Federal Questions and Colorado Responses on Waiver Amendment Application (PDF)
Correspondence:
- Colorado's Letter of Intent to Apply for a Waiver Amendment and Response (PDF)
- Notice of Preliminary Determination of Completeness for Amendment Application (PDF)
- Colorado Amendment Approval Letter and STCs (PDF)
Pass-through funding
- Colorado Pass Through Funding for the 2020 Year (PDF)
- Colorado Pass Through Funding for the 2021 Year (including adjustment for ARP) (PDF)
- Colorado Pass-Through Funding for 2022 Year (PDF)
- Colorado Pass-Through Funding for the 2023 Year (PDF)
- Colorado Pass-Through Funding for the 2024 Year (PDF)
Other Correspondence
- Agreement Between CMS and Colorado on Calculating Reinsurance Payments (PDF)
- Updated Agreement Between CMS and Colorado on Calculating Reinsurance Payments (PDF)
Delaware
On August 20, 2019, the Departments, having completed a review of Delaware’s application, approved Delaware’s State Innovation Waiver under section 1332 of the ACA. This approval is effective for January 1, 2020 through December 31, 2024.
On July 31, 2024, the Departments, having completed a review of Delaware's waiver extension application submitted on April 2, 2024, approved Delaware's waiver extension request under section 1332 of the ACA. This approval is effective for January 1, 2025, through December 31, 2029.
Initial Waiver (2020)
Application:
- Delaware Section 1332 State Innovation Waiver (PDF)
- Public Comments on Waiver during Federal Comment Period (PDF)
- Response to Public Comments on Waiver during Federal Comment Period (PDF)
- Fact Sheet (PDF)
Correspondence:
- Notice of Preliminary Determination of Completeness (PDF)
- Delaware Approval Letter and STCs (PDF)
Waiver Extension Request (2023)
Application:
- Delaware Section 1332 State Innovation Waiver: Extension Application (PDF)
- Fact Sheet: Waiver Extension (PDF)
- Federal Questions and Delaware Responses on Waiver Extension Application (PDF)
Correspondence:
- Delaware's Letter of Intent to Apply for a Waiver Extension and Response (PDF)
- Notice of Preliminary Determination of Completeness (PDF)
- Delaware Extension Approval Letter and STCs (PDF)
Pass-through funding
- Delaware Pass Through Funding for the 2020 Year (PDF)
- Delaware Pass Through for the 2021 Year (including adjustment for ARP) (PDF)
- Delaware Pass Through Funding for 2022 Year (PDF)
- Delaware Pass Through Funding for 2023 Year (PDF)
- Delaware Pass Through Funding for 2024 Year (PDF)
Other Correspondence
Georgia
On November 1, 2020, the Departments, having completed a review of Georgia’s application, approved Georgia’s State Innovation Waiver under section 1332 of the PPACA. This approval is effective for January 1, 2022 through December 31, 2026.
On April 29, 2022, the Departments sent a letter to Georgia informing the State that the Departments are suspending Part II of Georgia’s section 1332 waiver, the Georgia Access Model, that was initially approved on November 1, 2020, unless certain requirements are met. On July 27, 2022, Georgia submitted a written challenge to the Departments’ suspension determination. On August 9, 2022, the Departments sent letter to Georgia informing the State that the Departments are suspending Part II of Georgia's section 1332 waiver, the Georgia Access Model, effective August 9, 2022. CMS will continue to operate the FFE in Georgia and Georgia consumers will retain access to HealthCare.gov for Plan Year (PY) 2023 to purchase qualified health plans in the individual market. Georgia may submit a corrective action plan to bring its waiver, with the Georgia Access Model, into compliance with the statutory coverage guardrail for the Departments' consideration to resume implementation for PYs 2024-2026. To view the letters, please see below under ‘Correspondence.’
Application:
- Georgia Section 1332 State Innovation Waiver (12/23/19)
- Georgia Section 1332 State Innovation Waiver (7/31/20)
- Public comments on February 2020 waiver Part I during Federal Comment Period from February 6, 2020, through March 7, 2020 (10/8/20) (PDF)
- Public comments on July 2020 waiver Part II during Federal Comment Period from August 17 through September 11, 2020 (10/8/20) (PDF)
- Public comments on July 2020 waiver Part II during Federal Comment Period from September 12 through September 23, 2020 (10/8/20) (PDF)
- Public comments from organizations on July 2020 waiver Part II during Federal Comment Period from August 17 through September 23, 2020 (10/8/20) (PDF)
- Fact Sheet (11/1/20) (PDF)
Correspondence:
- Letter From Governor Kemp (2/5/20) (PDF)
- Notice of Preliminary Determination of Completeness for 12/23/19 Application (2/6/20) (PDF)
- Letter From Governor Kemp (7/8/20) (PDF)
- Notice of Preliminary Determination of Completeness for 8/17/20 Application (8/17/20) (PDF)
- Georgia Approval Letter and STCs (11/1/20) (PDF)
- Letter Requesting Updated Georgia Analysis (6/3/21) (PDF)
- Response Letter from Georgia (7/2/21) (PDF)
- Follow-up Letter to Georgia’s July 2 Response Letter (7/30/21) (PDF)
- Second Response Letter from Georgia (8/26/21) (PDF)
- Letter Informing Georgia of Public Comment Solicitation (11/09/21) (PDF)
- Request for Comment on the Georgia Access Model (PDF)
- Public comments on GA Access Model during Federal Comment Solicitation from November 9, 2021 through January 9, 2022 (1/14/22) (PDF)
- Public comments from organizations on GA Access Model during Federal Comment Solicitation from November 9, 2021 through January 9, 2022 (1/14/22) (PDF)
- Estimating the Coverage Impact of Georgia’s Section 1332 Waiver, with the Georgia Access Model (4/29/22) (PDF)
- Georgia Access Public Awareness Campaign and Outreach Strategy (as of 7/15/22; posted 4/21/23) (PDF)
- Georgia Access Operational Report (as of 8/8/22; posted 4/21/23) (PDF)
Pass-through funding:
- Georgia Pass Through Funding for the 2022 Year (PDF)
- Georgia Pass Through Funding for the 2023 Year (PDF)
- Georgia Pass Through Funding for the 2024 (PDF)
Other Correspondence:
Hawaii
On December 30, 2016, the Departments, having completed a review of Hawaii's application, approved Hawaii's State Innovation Waiver under section 1332 of the ACA and the state accepted the Specific Terms and Conditions (STCs). This approval is effective for January 1, 2017, through December 31, 2021.
On December 10, 2021, the Departments, having completed a review of Hawaii’s waiver extension application submitted on August 12, 2021, approved Hawaii’s 5-year extension request under section 1332 of the ACA. This approval is effective for January 1, 2022 through December 31, 2026.
Initial Waiver (2016)
Application:
Correspondence:
- Hawaii Approval Letter and signed STC (PDF)
- Notice of Preliminary Determination of Completeness (PDF)
- Letter from Hawaii to HHS in Response to HHS Questions on Waiver (PDF)
- Hawaii Notice of Preliminary Determination of Incompleteness (PDF)
Waiver Extension Request (2021)
Application:
- Hawaii Section 1332 State Innovation Waiver: Extension Application (PDF)
- Fact Sheet: Waiver Extension (PDF)
- Public Comment on Waiver Extension during Federal Comment Period (PDF)
- Response to Public Comment on Waiver Extension during Federal Comment Period (PDF)
Correspondence:
- Hawaii's Letter of Intent to Apply for a Waiver Extension and Response (PDF)
- Notice of Preliminary Determination of Completeness for Extension Application (PDF)
- Hawaii Extension Approval Letter and STCs (PDF)
Pass-through funding:
- Hawaii Pass Through Funding for the 2017 Year (PDF)
- Hawaii Pass Through Funding for the 2018 Year (PDF)
- Hawaii Pass Through Funding for the 2019 Year (PDF)
- Hawaii Pass Through Funding for the 2020 Year (PDF)
- Hawaii Pass Through Funding for the 2021 Year (PDF)
- Hawaii Pass Through Funding for the 2022 Year (PDF)
- Hawaii Pass Through Funding for the 2023 Year (PDF)
- Hawaii Pass Through Funding for the 2024 Year (PDF)
Idaho
On July 15, 2019, Idaho submitted a State Innovation Waiver application. The Departments determined that the application was not complete on August 29, 2019.
On August 16, 2022, the Departments, having completed a review of Idaho’s waiver application submitted on May 5, 2022, approved Idaho’s waiver application under section 1332 of the ACA. This approval is effective for January 1, 2023 through December 31, 2027.
Waiver (2019)
Application:
- Idaho Section 1332 State Innovation Waiver
- Public Comments on Waiver during Federal Comment Period (PDF)
Correspondence:
Waiver (2022)
Application:
- Idaho Section 1332 State Innovation Waiver
- Response to Public Comments on Waiver during Federal Comment Period (PDF)
- Fact Sheet (PDF)
Correspondence:
Pass-through funding
- Idaho Pass Through Funding for the 2023 Year (PDF)
- Idaho Pass Through Funding for the 2024 Year (PDF)
Iowa
On August 21, 2017, Iowa submitted a State Innovation Waiver application. The Departments deemed the application complete on September 19. The Departments accepted public comments on Iowa’s application from September 19, 2017 until October 19, 2017. Iowa withdrew the application on October 23, 2017.
Application:
- Iowa’s Section 1332 State Innovation Waiver
- Iowa Stopgap Measure Supplement (9/20/17) (PDF)
- Iowa Stopgap Measure Supplement (updated 10/6/17 supersedes 9/20/20 version) (PDF)
- Iowa Letter to Withdraw 1332 State Innovation Waiver (10/23/17) (PDF)
- Public Comments on Waiver during Federal Comment Period (PDF)
Correspondence:
- Letter of Preliminary Determination of Completeness (PDF)
- Iowa response to CMS 10/5/17 Questions (PDF)
- Iowa response to CMS 10/6/17 Questions (PDF)
- Iowa Stopgap Measure Supplemental Economic and Actuarial Analysis 10/13/17 (PDF)
- 10/19/17 Departments Letter to Iowa (PDF)
Maine
On July 30, 2018, the Departments, having completed a review of Maine’s application, approved Maine’s State Innovation Waiver under section 1332 of the ACA. This approval is effective for January 1, 2019, through December 31, 2023.
On July 15, 2022, the Departments, having completed a review of Maine’s waiver amendment application submitted on February 10, 2022, with an addendum submitted on March 23, 2022, approved Maine’s waiver amendment request under section 1332 of the ACA. This approval is effective for January 1, 2023 through December 31, 2027.
Initial Waiver (2018)
Application:
- Maine Section 1332 State Innovation Waiver
- Public Comments on Waiver during Federal Comment Period (PDF)
- Response to Public Comments on Waiver during Federal Comment Period (PDF)
- Fact Sheet (PDF)
Correspondence:
- Notice of Preliminary Determination of Completeness (PDF)
- Maine Approval Letter and STCs (PDF)
Waiver Amendment Request (2022)
Application:
- Maine Section 1332 State Innovation Waiver: Amendment Application
- Addendum to Amendment Application
Correspondence:
- Maine’s Letter of Intent to Apply for a Waiver Amendment and Response (PDF)
- Notice of Preliminary Determination of Completeness for Amendment Application (PDF)
- Maine’s Merged Market Proposal Letter (PDF)
- Maine Amendment Approval Letter and STCs (PDF)
Pass-through funding:
- Maine Pass Through Funding for the 2019 Year (PDF)
- Maine Pass Through Funding for the 2020 Year (PDF)
- Maine Pass Through Funding for the 2021 Year (including adjustment for ARP) (PDF)
- Maine Pass Through Funding for the 2022 Year (PDF)
- Maine Pass Through Funding for the 2023 Year (PDF)
- Maine Pass Through Funding for the 2024 Year (PDF)
Maryland
On August 22, 2018, the Departments, having completed a review of Maryland’s application, approved Maryland’s State Innovation Waiver under section 1332 of the ACA. This approval is effective for January 1, 2019, through December 31, 2023.
On June 28, 2023, the Departments, having completed a review of Maryland's waiver extension application submitted on March 20, 2023, approved Maryland's State Innovation Waiver under section 1332 of the ACA. This approval is effective for January 1, 2024 through December 31, 2028.
On July 15, 2024, Maryland submitted a request to amend its State Innovation Waiver from January 1, 2026, through December 31, 2028. On August 22, 2024, the Departments deemed Maryland’s waiver application complete. Federal public comments will be accepted from August 22, 2024, through September 20, 2024. To submit a public comment, please email stateinnovationwaivers@cms.hhs.gov.
Initial Waiver (2018)
Application:
- Maryland Section 1332 State Innovation Waiver- Opens in a new window
- Public Comments on Waiver during Federal Comment Period (PDF)
- Responses to Public Comments on Waiver during Federal Comment Period (PDF)
- Fact Sheet (PDF)
Correspondence:
- Notice of Preliminary Determination of Completeness (PDF)
- Maryland Approval Letter and STCs (PDF)
Waiver Extension Request (2023)
Application:
- Maryland Section 1332 State Innovation Waiver:Extension Application
- Response to Public Comments on Waiver Extension during Federal Comment Period (PDF)
- Fact Sheet: Waiver Extension (PDF)
Correspondence:
- Maryland’s Letter of Intent to Apply for a Waiver Extension and Response (PDF)
- Notice of Preliminary Determination of Completeness for Extension Application (PDF)
- Maryland Waiver Extension Approval Letter and STCs (PDF)
Waiver Amendment Request (2024)
Application:
Correspondence:
- Maryland Letter of Intent to Apply for a Waiver Amendment and Response (PDF)
- Notice of Preliminary Determination of Completeness for Amendment Application (PDF)
Pass-through Funding:
- Maryland Pass Through Funding for the 2019 Year (PDF)
- Maryland Pass Through Funding for the 2020 Year (PDF)
- Maryland Pass Through Funding for the 2021 Year (including adjustment for ARP) (PDF)
- Maryland Pass Through Funding for the 2022 Year (PDF)
- Maryland Pass Through Funding for the 2023 Year (PDF)
- Maryland Pass Through Funding for the 2024 Year (PDF)
Other Correspondence:
Massachusetts
On September 8, 2017, Massachusetts submitted a State Innovation Waiver application. The Departments determined that the application was not complete on October 23, 2017.
Application:
Correspondence:
Minnesota
On September 22, 2017, the Departments, having completed a review of Minnesota’s application, approved Minnesota’s State Innovation Waiver under section 1332 of the PPACA. On October 19, 2017, the Departments sent a revised approval, and on October 20, 2017, the state accepted the Specific Terms and Conditions (STCs). This approval is effective for January 1, 2018, through December 31, 2022.
On December 22, 2021, Minnesota submitted a section 1332 waiver extension application to extend its currently approved waiver. The Departments determined that the application was incomplete on January 27, 2022.
On July 13, 2022, the Departments, having completed a review of Minnesota's waiver extension application submitted on May 12, 2022, approved Minnesota's waiver extension request under section 1332 of the ACA. This approval is effective for January 1, 2023 through December 31, 2027.
Initial Waiver (2017)
Application:
- Minnesota Section 1332 State Innovation Waiver (PDF)
- Public Comments on Waiver during Federal Comment Period (PDF)
- Response to Public Comments on Waiver during Federal Comment Period (PDF)
Correspondence:
- Notice of Preliminary Determination of Completeness (PDF)
- Minnesota Approval Letter and signed STC (PDF)
Waiver Extension Request (2021/2022)
Application:
- Minnesota Section 1332 State Innovation Waiver: Extension Application (PDF)
- Minnesota Section 1332 State Innovation Waiver: Revised Extension Application with Responses to Federal Questions (PDF)
- Waiver Extension: Actuarial Analysis (PDF)
Correspondence:
- Minnesota’s Letter of Intent to Apply for a Waiver Extension and Response (PDF)
- Notice of Preliminary Determination of Incompleteness (PDF)
- Notice of Preliminary Determination of Completeness(PDF)
- Minnesota Waiver Extension Approval Letter and STCs (PDF)
Pass-through funding:
- Minnesota Pass Through Funding for the 2018 Year (PDF)
- Minnesota Pass Through Funding for the 2019 Year (PDF)
- Minnesota Pass Through Funding for the 2020 Year (PDF)
- Minnesota Pass Through Funding for the 2021 Year (including adjustment for ARP) (PDF)
- Minnesota Pass Through Funding for the 2022 Year (PDF)
- Minnesota Pass Through Funding for the 2023 Year (PDF)
- Minnesota Pass Through Funding for the 2024 Year (PDF)
Other Correspondence
Montana
On August 16, 2019, the Departments, having completed a review of Montana’s application, approved Montana’s State Innovation Waiver under section 1332 of the ACA. This approval is effective for January 1, 2020 through December 31, 2024.
On May 17, 2024, Montana submitted a request to extend its State Innovation Waiver from January 1, 2025, through December 31, 2029. On June 14, 2024, the Departments deemed Montana's waiver application as complete. Federal public comments will be accepted from June 14, 2024, through July 14, 2024. To submit a public comment, please email stateinnovationwaivers@cms.hhs.gov. To view Montana’s extension application, please visit the Waiver Extension Request section below.
Initial Waiver (2019)
Application:
- Montana Section 1332 State Innovation Waiver
- Public Comments on Waiver during the Federal Comment Period (PDF)
- Responses to Public Comments on Waiver during Federal Comment Period (PDF)
- Fact Sheet (PDF)
Correspondence:
- Notice of Preliminary Determination of Completeness (PDF)
- Montana Approval Letter and STCs (PDF)
Pass-through funding:
- Montana Pass Through Funding for the 2020 Year (PDF)
- Montana Pass Through Funding for the 2021 Year (including adjustment for ARP) (PDF)
- Montana Pass Through Funding for the 2022 Year (PDF)
- Montana Pass Through Funding for the 2023 Year (PDF)
- Montana Pass Through Funding for the 2024 Year(PDF)
Waiver Extension Request (2024)
Application:
Correspondence:
- Montana's Letter of Intent to Apply for a Waiver Extension and Response (PDF)
- Notice of Preliminary Determination of Completeness (PDF)
Nevada
On December 29, 2023, Nevada submitted a State Innovation Waiver application. On February 12, 2024, the Departments deemed Nevada’s waiver application as complete. Federal public comments were accepted from February 12, 2024, through March 14, 2024. On March 21, 2024, Nevada requested that the Departments pause review of the waiver application. On August 23, 2024, Nevada submitted an updated waiver application and review of the waiver resumed. Federal public comments will be accepted from August 26, 2024, through September 25, 2024. To submit a public comment, please email stateinnovationwaivers@cms.hhs.gov.
Application
- Nevada Section 1332 State Innovation Waiver
- Addendum to Waiver Application (PDF)
Correspondence
- Notice of Preliminary Determination of Completeness for Waiver Application (PDF)
- Letter from NV Department of Health and Human Services Pausing Review of Waiver (PDF)
New Hampshire
On August 5, 2020 the Departments, having completed a review of New Hampshire’s application, approved New Hampshire’s State Innovation Waiver under section 1332 of the PPACA. This approval is effective for January 1, 2021 through December 31, 2025.
Initial Waiver (2020)
Application:- New Hampshire Section 1332 State Innovation Waiver
- Public Comments on Waiver during Federal Comment Period (PDF)
- Responses to Public Comments on Waiver during Federal Comment Period (PDF)
- Fact Sheet (PDF)
Correspondence
- Notice of Preliminary Determination of Completeness (PDF)
- New Hampshire Approval Letter and STCs (PDF)
- Agreement Between CMS and New Hampshire on Calculating Reinsurance Payments (PDF)
Pass-through funding:
- New Hampshire Pass Through Funding for the 2021 Year (including adjustment for ARP) (PDF)
- New Hampshire Pass Through Funding for the 2022 Year (PDF)
- New Hampshire Pass Through Funding for the 2023 Year (PDF)
- New Hampshire Pass Through Funding for the 2024 Year(PDF)
Waiver Extension Request (2023)
Correspondence:
New Jersey
On August 16, 2018, the Departments, having completed a review of New Jersey’s application, approved New Jersey’s State Innovation Waiver under section 1332 of the ACA. This approval is effective for January 1, 2019, through December 31, 2023.
On August 15, 2023, the Departments, having completed a review of New Jersey's waiver extension application submitted on July 6, 2023, and addendum submitted on July 11, 2023, approved New Jersey's State Innovation Waiver under section 1332 of the ACA. This approval is effective for January 1, 2024 through December 31, 2028.
Initial Waiver (2018)
Application:
- New Jersey Section 1332 State Innovation Waiver
- Public Comments on Waiver during the Federal Comment Period (PDF)
- Responses to Public Comments on Waiver during Federal Comment Period (PDF)
- Fact Sheet (PDF)
Correspondence:
- Notice of Preliminary Determination of Completeness (PDF)
- New Jersey Approval Letter and STCs (PDF)
Pass-through funding:
- New Jersey Pass Through Funding for the 2019 Year (PDF)
- New Jersey Pass Through Funding for the 2020 Year (PDF)
- New Jersey Pass Through Funding for the 2021 Year (including adjustment for ARP) (PDF)
- New Jersey Pass Through Funding for the 2022 Year (PDF)
- New Jersey Pass Through Funding for the 2023 Year (PDF)
- New Jersey Pass Through Funding for the 2024 Year(PDF)
Waiver Extension Request (2023)
Application:- New Jersey Section 1332 State Innovation Waiver: Extension Application
- Fact Sheet (PDF)
Correspondence:
- New Jersey’s Letter of Intent to Apply for a Waiver Extension & Amendment and Response (PDF)
- Notice of Preliminary Determination of Completeness (PDF)
- New Jersey Waiver Extension Approval Letter and STCs (PDF)
New York
On March 1, 2024, the Departments, having completed a review of New York’s application, approved New York’s State Innovation Waiver under section 1332 of the ACA. This approval is effective for April 1, 2024, through December 31, 2028.
On June 28, 2024, New York submitted a request to amend its State Innovation Waiver. On July 24, 2024, the Departments deemed New York’s waiver application complete. Federal public comments will be accepted from July 24, 2024, through August 23, 2024. To submit a public comment, please email stateinnovationwaivers@cms.hhs.gov.
Initial Waiver (2023)
Application:
- New York Section 1332 State Innovation Waiver
- Addendum to Waiver Application (8/23/23) (PDF)
- Addendum to Waiver Application (11/14/23) (PDF)
- Addendum to Wavier Application (12/18/23) (PDF)
Correspondence:
- Notice of Preliminary Determination of Completeness (PDF)
- Letter from NY Department of Health Pausing Review of Waiver (PDF)
- New York Approval Letter and STCs (PDF)
Other Correspondence:
Pass-through funding:
Waiver Amendment Request (2024)
Application:
- New York Section 1332 State Innovation Waiver: Amendment Application
- Public Comments on Amendment Application during Federal Comment Period (PDF)
Correspondence:
- New York’s Letter of Intent to Apply for a Waiver Amendment and Response. (PDF)
- New York Amendment Notice of Preliminary Determination of Completeness(PDF)
North Dakota
On July 31, 2019, the Departments, having completed a review of North Dakota’s application, approved North Dakota’s State Innovation Waiver under section 1332 of the ACA. This approval is effective for January 1, 2020 through December 31, 2024.
Initial Waiver (2019)
Application:
- North Dakota Section 1332 State Innovation Waiver
- Public Comments on Waiver during the Federal Comment Period (PDF)
- Responses to Public Comments on Waiver during Federal Comment Period (PDF)
- Fact Sheet (PDF)
Correspondence:
- Notice of Preliminary Determination of Completeness (PDF)
- North Dakota Approval Letter and STCs (PDF)
Waiver Extension Request (2024)
Correspondence:
Pass-through funding:
- North Dakota Pass Through Funding for the 2020 Year (PDF)
- North Dakota Pass Through Funding for the 2021 Year (including adjustment for ARP) (PDF)
- North Dakota Pass Through Funding for the 2022 Year (PDF)
- North Dakota Pass Through Funding for the 2023 Year (PDF)
- North Dakota Pass Through Funding for the 2024 Year(PDF)
Other Correspondence:
Ohio
On March 30, 2018, Ohio submitted a State Innovation Waiver application. The Departments determined that the application was not complete on May 17, 2018.
Application:
Correspondence:
Oklahoma
On August 16, 2017, Oklahoma submitted a State Innovation Waiver application. The Departments deemed the application complete on August 24. The Departments accepted public comments on Oklahoma’s application from August 24, 2017 until September 23, 2017. Oklahoma withdrew the application on September 29, 2017.
Application:
- Oklahoma Section 1332 State Innovation Waiver- Opens in a new window
- Public Comments on Waiver during Federal Comment Period (PDF)
Correspondence:
- Notice of Preliminary Determination of Completeness (PDF)
- Oklahoma Letter to Withdraw 1332 State Innovation Waiver (PDF)
Oregon
On October 18, 2017, the Departments, having completed a review of Oregon’s application, approved Oregon’s State Innovation Waiver under section 1332 of the PPACA. On October 19, the state accepted the Specific Terms and Conditions (STCs). This approval is effective for January 1, 2018, through December 31, 2022.
On July 13, 2022, the Departments, having completed a review of Oregon's waiver extension application submitted on March 31, 2022, approved Oregon's waiver extension request under section 1332 of the ACA. This approval is effective for January 1, 2023 through December 31, 2027.
Initial Waiver (2017)
Application:
- Oregon Section 1332 State Innovation Waiver- Opens in a new window
- Public Comments on Waiver during Federal Comment Period (PDF)
- Response to Public Comments on Waiver during Federal Comment Period (PDF)
Correspondence:
- Oregon Approval Letter and signed STC (PDF)
- Notice of Preliminary Determination of Completeness (PDF)
Waiver Extension Request (2022)
Application:
- Oregon Section 1332 State Innovation Waiver: Extension Application with Responses to Federal Questions
- Public Comments on Waiver Extension during Federal Comment Period (PDF)
- Response to Public Comments on Waiver Extension during Federal Comment Period (PDF)
- Fact Sheet: Waiver Extension (PDF)
Correspondence:
- Oregon’s Letter of Intent to Apply for a Waiver Extension and Response (PDF)
- Notice of Preliminary Determination of Completeness for Extension Application (PDF)
- Oregon Waiver Extension Approval Letter and STCs (PDF)
Pass-through funding:
- Oregon Pass Through Funding for the 2018 Year (PDF)
- Oregon Pass Through Funding for the 2019 Year (PDF)
- Oregon Pass Through Funding for the 2020 Year (PDF)
- Oregon Pass Through Funding for the 2021 Year (including adjustment for ARP) (PDF)
- Oregon Pass Through Funding for the 2022 Year (PDF)
- Oregon Pass Through Funding for the 2023 Year (PDF)
- Oregon Pass Through Funding for the 2024 Year (PDF)
Pennsylvania
On July 24, 2020, the Departments, having completed a review of Pennsylvania’s application, approved Pennsylvania’s State Innovation Waiver under section 1332 of the PPACA. This approval is effective for January 1, 2021 through December 31, 2025.
Initial Waiver (2020)
Application:
- Pennsylvania Section 1332 State Innovation Waiver
- Public Comments on Waiver during Federal Comment Period (PDF)
- Responses to Public Comments on Waiver during Federal Comment Period (PDF)
- Fact Sheet (PDF)
Correspondence:
- Notice of Preliminary Determination of Completeness (PDF)
- Pennsylvania Approval Letter and STCs (PDF)
- Agreement Between CMS and Pennsylvania on Calculating Reinsurance Payments (PDF)
Pass-through funding:
- Pennsylvania Pass Through Funding for the 2021 Year (including adjustment for ARP) (PDF)
- Pennsylvania Pass Through Funding for the 2022 Year (PDF)
- Pennsylvania Pass Through Funding for the 2023 Year (PDF)
- Pennsylvania Pass Through Funding for the 2024 Year(PDF)
Waiver Extension Request (2023)
Correspondence:
Rhode Island
On August 26, 2019, the Departments, having completed a review of Rhode Island’s application, approved Rhode Island’s State Innovation Waiver under section 1332 of the PPACA. This approval is effective for January 1, 2020 through December 31, 2024.
On July 8, 2024, Rhode Island submitted a request to extend its State Innovation Waiver from January 1, 2025, through December 31, 2029. On August 7, 2024, the Departments deemed Rhode Island’s waiver application complete. Federal public comments will be accepted from August 7, 2024, through September 5, 2024. To submit a public comment, please email stateinnovationwaivers@cms.hhs.gov.
Initial Waiver (2019)
Application:
- Rhode Island Section 1332 State Innovation Waiver
- Public Comments on Waiver during Federal Comment Period (PDF)
- Responses to Public Comments on Waiver during Federal Comment Period (PDF)
- Fact Sheet (PDF)
Correspondence:
- Notice of Preliminary Determination of Completeness (PDF)
- Rhode Island Approval Letter and STCs (PDF)
Waiver Extension Request (2023)
Application:
Correspondence:
- Rhode Island's Letter of Intent to Apply for a Waiver Extension and Response (PDF)
- Notice of Preliminary Determination of Completeness (PDF)
Pass-through funding:
- Rhode Island Pass Through Funding for the 2020 Year (PDF)
- Rhode Island Pass Through Funding for the 2021 Year (including adjustment for ARP) (PDF)
- Rhode Island Pass Through Funding for the 2022 Year (PDF)
- Rhode Island Pass Through Funding for the 2023 Year (PDF)
- Rhode Island Pass Through Funding for the 2024 Year(PDF)
Virginia
On May 18, 2022, the Departments, having completed a review of Virginia's application, approved Virginia's State Innovation Waiver under section 1332 of the ACA. This approval is effective for January 1, 2023 through December 31, 2027.
Application:
- Virginia Section 1332 State Innovation Waiver
- Public Comments on Waiver during Federal Comment Period (PDF)
- Responses to Public Comments on Waiver during Federal Comment Period (PDF)
- Fact Sheet (PDF)
Correspondence:
- Notice of Preliminary Determination of Completeness (PDF)
- Virginia Approval Letter and STCs (PDF)
Other Correspondence
Pass-through Funding
- Virginia Pass Through Funding for the 2023 Year (PDF)
- Virginia Pass Through Funding for the 2024 Year(PDF)
Vermont
On April 25, 2016, Vermont submitted a State Innovation Waiver application. The Departments determined that the application was not complete on June 9, 2016.
Application:
Correspondence:
Washington
On December 9, 2022, the Departments, having completed a review of Washington’s waiver application submitted on May 13, 2022, approved Washington’s State Innovation Waiver under section 1332 of the ACA. This approval is effective for January 1, 2024, through December 31, 2028.
Waiver (2022)
Application:
- Washington Section 1332 State Innovation Waiver
- Public Comments on Waiver during Federal Comment Period (PDF)
- Public Comments from Organizations on Waiver during Federal Comment Period (PDF)
- Responses to Public Comments on Waiver during Federal Comment Period(PDF)
- Fact Sheet: Waiver Approval(PDF)
- Federal Questions and Washington Responses on Waiver Application(PDF)
Correspondence:
- Washington Notice of Preliminary Determination of Completeness (PDF)
- Washington Waiver Approval Letter and STCs (PDF)
Wisconsin
On July 29, 2018, the Departments, having completed a review of Wisconsin’s application, approved Wisconsin’s State Innovation Waiver under section 1332 of the ACA and the state accepted the Specific Terms and Conditions (STCs). This approval is effective for January 1, 2019, through December 31, 2023.
On December 1, 2022, the Departments, having completed a review of Wisconsin’s waiver extension application submitted on May 5, 2022, approved Wisconsin’s State Innovation Waiver under section 1332 of the ACA. This approval is effective for January 1, 2024, through December 31, 2028.
Initial Waiver (2018)
Application:
- Wisconsin Section 1332 State Innovation Waiver
- Public Comments on Waiver during Federal Comment Period (PDF)
- Response to Public Comments on Waiver during Federal Comment Period (PDF)
- Fact Sheet (PDF)
Correspondence:
- Notice of Preliminary Determination of Completeness (PDF)
- Wisconsin Approval Letter and signed STC (PDF)
Waiver Extension Request (2021)
Application:
- Wisconsin Section 1332 State Innovation Waiver: Extension Application
- Fact Sheet: Waiver Extension (PDF)
Correspondence:
- Notice of Preliminary Determination of Completeness for Extension Application (PDF)
- Wisconsin Extension Approval Letter and STCs (PDF)
Pass-through funding:
- Wisconsin Pass Through Funding for the 2019 Year (PDF)
- Wisconsin Pass Through Funding for the 2020 Year (PDF)
- Wisconsin Pass Through Funding for the 2021 Year (including adjustment for ARP) (PDF)
- Wisconsin Pass Through Funding for the 2022 Year (PDF)
- Wisconsin Pass Through Funding for the 2023 Year (PDF)
- Wisconsin Pass Through Funding for the 2024 Year(PDF)
Frequently Asked Questions about the 1332 State Innovation Waivers
1. What is a State Innovation Waiver?
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.
2. What can be waived pursuant to a State Innovation Waiver?
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:
- Part I of Subtitle D of Title I of the Affordable Care Act (relating to establishing qualified health plans (QHPs));
- Part II of Subtitle D of Title I of the ACA (relating to consumer choices and insurance competition through health insurance marketplaces);
- Sections 36B of the Internal Revenue Code and 1402 of the ACA (relating to premium tax credits and cost-sharing reductions for plans offered within the marketplaces);
- Section 4980H of the Internal Revenue Code (relating to employer shared responsibility); and
- Section 5000A of the Internal Revenue Code (relating to individual shared responsibility).
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.
3. How do states apply?
States should submit their completed application in an electronic format to the Secretary of Health and Human Services at stateinnovationwaivers@cms.hhs.gov.
4. Who can states contact if they are interested in submitting a waiver application and have questions?
5. Will states have to apply to each relevant agency separately when submitting a State Innovation Waiver?
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.
6. When must states submit applications for approval? How long will the process take?
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.
7. What guidance and regulations exist for State Innovation Waivers?
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.
8. What do states have to include with their application?
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.
