Press release

CMS Responds to States and Releases State Relief and Empowerment Waiver Application Resources

Resource tools designed to help states better understand waiver regulations and available resources

Today, the Centers for Medicare & Medicaid Services (CMS), released new resources to support states with improving their health insurance markets and making coverage more affordable through State Relief and Empowerment Waivers, also known as section 1332 waivers. These new resources include a checklist of required waiver elements and model templates designed to help states better understand and navigate the section 1332 waiver application process.   

“To date, the Trump Administration has approved seven reinsurance-type waivers that lowered premiums and strengthened insurance markets—showing our strong commitment to help states achieve better results for their citizens,” said CMS Administrator Seema Verma. “While states have tremendous opportunities to strengthen their health insurance markets through a State Relief and Empowerment Waiver, we’ve also heard from states that they need more help and detail from CMS in putting together their waiver applications. This new package of resources should reduce some of the guesswork and burden on states as they craft their waiver applications.”

Between 2013 and 2017, average premiums in states using doubled. Issuers also began exiting health insurance markets in 2017 and, by 2018, more than half of all counties across America had only one issuer. To begin addressing these problems, President Trump issued an executive order directing agencies to minimize the economic burden of the Affordable Care Act (ACA) and to provide greater flexibility to states in implementing healthcare programs. 

CMS and the Department of the Treasury issued new guidance in 2018 giving states greater flexibility to waive certain ACA requirements under Section 1332 of the ACA with the goal of stabilizing insurance markets and providing more affordable coverage options to state residents. Shortly after issuing the guidance, CMS issued four waiver concepts illustrating how states can take advantage of this new flexibility. The concepts detail a number of innovative approaches states can pursue to improve their markets, including restructuring the ACA’s premium tax credit to make coverage more affordable for young and healthy enrollees, allowing tax credits to be deposited into consumer-directed accounts that can be used to buy a broader range of health insurance plans, and pursuing innovative strategies to address high-cost enrollees—all while preserving access to coverage and improving options for people with pre-existing conditions.

The tools released today include an overview that further details how each wavier concept can be used to improve insurance markets and templates outlining what states need to address in their applications. The templates also identify areas of flexibility and variations states can consider. For example, states are free to combine multiple waiver concepts or come up with their own waiver ideas. States are not required to use these resources to submit a section 1332 waiver application.  A state’s use of any of these resources does not guarantee approval of a section 1332 waiver application, and the state will have to comply with the applicable statute and regulations. 

Because states have found similar materials helpful in the past, CMS is also releasing an updated checklist that states can use in applying for a State Relief and Empowerment Waiver. 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.

The resources shared today are another part of CMS’s efforts to work with states to help them develop insurance markets that best meet the needs of their residents.

To view the waiver concepts, templates and application checklist, visit:

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