{ "id": "R44760", "type": "CRS Report", "typeId": "R", "number": "R44760", "active": true, "source": "CRSReports.Congress.gov, EveryCRSReport.com", "versions": [ { "source_dir": "crsreports.congress.gov", "title": "State Innovation Waivers: Frequently Asked Questions", "retrieved": "2021-03-01T04:03:45.346567", "id": "R44760_20_2021-01-29", "formats": [ { "filename": "files/2021-01-29_R44760_884059961ff8864d0de3a8874cb77857b33b0c21.pdf", "format": "PDF", "url": "https://crsreports.congress.gov/product/pdf/R/R44760/20", "sha1": "884059961ff8864d0de3a8874cb77857b33b0c21" }, { "format": "HTML", "filename": "files/2021-01-29_R44760_884059961ff8864d0de3a8874cb77857b33b0c21.html" } ], "date": "2021-01-29", "summary": null, "source": "CRSReports.Congress.gov", "typeId": "R", "active": true, "sourceLink": "https://crsreports.congress.gov/product/details?prodcode=R44760", "type": "CRS Report" }, { "source": "EveryCRSReport.com", "id": 610018, "date": "2019-12-02", "retrieved": "2019-12-13T15:08:44.442155", "title": "State Innovation Waivers: Frequently Asked Questions", "summary": "Section 1332 of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) provides states with the option to waive specified requirements of the ACA. In the absence of these requirements, a state is to implement its own plan to provide health insurance coverage to state residents that meets the ACA\u2019s terms. \nUnder a state innovation waiver, a state can apply to waive ACA requirements related to qualified health plans, health insurance exchanges, premium tax credits, cost-sharing subsidies, the individual mandate, and the employer mandate. The state can apply to waive any or all of these requirements, in part or in their entirety.\nTo obtain approval for a waiver application, a state must show that the plan it will implement in the absence of the waived provision(s) meets certain requirements. Under current guidance, the state\u2019s plan must ensure that a comparable number of state residents have health insurance coverage under the plan as would have had coverage absent the waiver. It also must provide a comparable number of residents with the opportunity to purchase coverage that is as affordable and comprehensive as would have been available absent the waiver. However, applications do not need to demonstrate that the comparable number of residents would be enrolled in the affordable and comprehensive coverage, as would have been required under previous guidance. Finally, the state\u2019s plan cannot increase the federal deficit.\nThe Secretary of the Department of Health and Human Services (HHS) and the Secretary of the Treasury share responsibility for reviewing state innovation waiver applications and deciding whether to approve applications. The earliest a state innovation waiver could have gone into effect was January 1, 2017.\nIn October 2018, the Centers for Medicare & Medicaid Services (CMS) released updated guidance regarding the state innovation waiver process that superseded previously issued CMS guidance from December 2015. In general, the updated guidance attempts to make it easier for a state plan to be approved. The updated guidance applies to all waiver applications that had not been approved prior to the date of the guidance\u2019s release. Waivers approved under the previously issued guidance did not require reconsideration.\nAs of the date of this report, 13 states\u2014Alaska, Colorado, Delaware, Hawaii, Maine, Maryland, Minnesota, Montana, New Jersey, North Dakota, Oregon, Rhode Island, and Wisconsin\u2014have approved state innovation waivers. Eight of these waivers were considered and approved under the initial state innovation waiver guidance, and five were considered and approved under the current state innovation waiver guidance. Twelve of the 13 approved waivers implement a variant of a statewide individual market reinsurance program.\nIdaho, Massachusetts, Ohio, and Vermont have submitted applications and received notification that their applications were incomplete. It does not appear that any of these states has modified its application in response to the notification (as of the date of this report). If these states take action, any further review of their waiver application would be under the updated state innovation waiver guidance. Three states\u2014California, Iowa, and Oklahoma\u2014submitted waiver applications and have since withdrawn their applications.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "https://www.crs.gov/Reports/R44760", "sha1": "c0a3016132eb11ab15dae7c1bcb53adb44e44015", "filename": "files/20191202_R44760_c0a3016132eb11ab15dae7c1bcb53adb44e44015.html", "images": {} }, { "format": "PDF", "encoding": null, "url": "https://www.crs.gov/Reports/pdf/R44760", "sha1": "a03ba0ee66898dca9c2bd57e3d235f5c18ab3518", "filename": "files/20191202_R44760_a03ba0ee66898dca9c2bd57e3d235f5c18ab3518.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4790, "name": "Private Health Insurance" } ] }, { "source": "EveryCRSReport.com", "id": 589673, "date": "2019-01-09", "retrieved": "2019-01-09T23:06:17.479124", "title": "State Innovation Waivers: Frequently Asked Questions", "summary": "Section 1332 of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) provides states with the option to waive specified requirements of the ACA. In the absence of these requirements, a state is to implement its own plan to provide health insurance coverage to state residents that meets the ACA\u2019s terms. \nUnder a state innovation waiver, a state can apply to waive ACA requirements related to qualified health plans, health insurance exchanges, premium tax credits, cost-sharing subsidies, the individual mandate, and the employer mandate. The state can apply to waive any or all of these requirements, in part or in their entirety.\nTo obtain approval for a waiver application, a state must show that the plan it will implement in the absence of the waived provision(s) meets certain requirements. Under current guidance, the state\u2019s plan must provide coverage to as many state residents as would be covered absent the waiver and must make available to a comparable number of residents coverage that is both as affordable and as comprehensive as would be absent the waiver. However, applications do not need to demonstrate that the affordable and comprehensive coverage will be purchased by a comparable number of state residents. Additionally, the state\u2019s plan cannot increase the federal deficit.\nThe Secretary of the Department of Health and Human Services (HHS) and the Secretary of the Treasury share responsibility for reviewing state innovation waiver applications and deciding whether to approve applications. The earliest a state innovation waiver could have gone into effect was January 1, 2017.\nIn October 2018, the Centers for Medicare & Medicaid Services (CMS) released updated guidance regarding the state innovation waiver process that superseded previously issued CMS guidance from December 2015. In general, the updated guidance attempts to make it easier for a state plan to be approved. The updated guidance applies to all waiver applications that had not been approved prior to the date of the guidance\u2019s release. Waivers approved under the previously issued guidance did not require reconsideration.\nAs of the date of this report, eight states\u2014Alaska, Hawaii, Maine, Maryland, Minnesota, New Jersey, Oregon, and Wisconsin\u2014have approved state innovation waivers. All of these waivers were considered and approved under the initial state innovation waiver guidance, and all but one of the approved waivers implement a variant of a statewide individual market reinsurance program.\nMassachusetts, Ohio, and Vermont have submitted applications and received notification that their applications were incomplete. It does not appear that any of these states has modified its application in response to the notification (as of the date of this report). If these states take action, any further review of their waiver application would be under the updated state innovation waiver guidance. Three states\u2014California, Iowa, and Oklahoma\u2014submitted waiver applications and have since withdrawn their applications.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R44760", "sha1": "f7e1d32a78b413b68d6a9c1db9504514e4f90fd2", "filename": "files/20190109_R44760_f7e1d32a78b413b68d6a9c1db9504514e4f90fd2.html", "images": {} }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R44760", "sha1": "81019f759f4875b6e729dc54c999a06d576cae44", "filename": "files/20190109_R44760_81019f759f4875b6e729dc54c999a06d576cae44.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4790, "name": "Private Health Insurance" } ] }, { "source": "EveryCRSReport.com", "id": 584997, "date": "2018-06-05", "retrieved": "2018-10-05T23:40:11.257741", "title": "State Innovation Waivers: Frequently Asked Questions", "summary": "Section 1332 of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) provides states with the option to waive specified requirements of the ACA. In the absence of these requirements, the state is to implement its own plan to provide health insurance coverage to state residents that meets the ACA\u2019s terms. \nUnder a state innovation waiver, a state can apply to waive ACA requirements related to qualified health plans, health insurance exchanges, premium tax credits, cost-sharing subsidies, the individual mandate, and the employer mandate. The state can apply to waive any or all of these requirements, in part or in their entirety.\nTo obtain approval for a waiver application, a state must show that the plan it will implement in the absence of the waived provision(s) meets certain requirements. The state\u2019s plan must ensure that as many state residents have health insurance coverage under the plan as would have had coverage absent the waiver, and the coverage must be as affordable and comprehensive as it would have been absent the waiver. Additionally, the state\u2019s plan cannot increase the federal deficit. \nThe Secretary of the Department of Health and Human Services (HHS) and the Secretary of the Treasury share responsibility for reviewing state innovation waiver applications and deciding whether to approve applications. The earliest a state innovation waiver could have gone into effect was January 1, 2017. \nAs of the date of this report, four states\u2014Alaska, Hawaii, Minnesota, and Oregon\u2014have approved state innovation waivers. Wisconsin has submitted a waiver application, and HHS and the Treasury have made a preliminary determination that the application is complete. The entire application is available to the public for review and comment through June 8, 2018. Ohio, Massachusetts, and Vermont have submitted applications and received notification that their applications were incomplete. It does not appear that any of these states has modified its application in response to the notification (as of the date of this report). Three states\u2014California, Iowa, and Oklahoma\u2014submitted waiver applications and have since withdrawn their applications.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R44760", "sha1": "ac0e2af27202932f243a03a416dfb572cff1126a", "filename": "files/20180605_R44760_ac0e2af27202932f243a03a416dfb572cff1126a.html", "images": {} }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R44760", "sha1": "571c52f2d326dcaeecf610160b8a750fc8d26723", "filename": "files/20180605_R44760_571c52f2d326dcaeecf610160b8a750fc8d26723.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4790, "name": "Private Health Insurance" } ] }, { "source": "EveryCRSReport.com", "id": 579638, "date": "2018-03-28", "retrieved": "2018-04-03T13:28:55.638857", "title": "State Innovation Waivers: Frequently Asked Questions", "summary": "Section 1332 of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) provides states with the option to waive specified requirements of the ACA. In the absence of these requirements, the state is to implement its own plan to provide health insurance coverage to state residents that meets the ACA\u2019s terms. \nUnder a state innovation waiver, a state can apply to waive ACA requirements related to qualified health plans, health insurance exchanges, premium tax credits, cost-sharing subsidies, the individual mandate, and the employer mandate. The state can apply to waive any or all of these requirements, in part or in their entirety.\nTo obtain approval for a waiver application, a state must show that the plan it will implement in the absence of the waived provision(s) meets certain requirements. The state\u2019s plan must ensure that as many state residents have health insurance coverage under the plan as would have had coverage absent the waiver, and the coverage must be as affordable and comprehensive as it would have been absent the waiver. Additionally, the state\u2019s plan cannot increase the federal deficit. \nThe Secretary of the Department of Health and Human Services (HHS) and the Secretary of the Treasury share responsibility for reviewing state innovation waiver applications and deciding whether to approve applications. The earliest a state innovation waiver could have gone into effect was January 1, 2017. \nAs of the date of this report, four states\u2014Alaska, Hawaii, Minnesota, and Oregon\u2014have approved state innovation waivers. Three states\u2014California, Iowa, and Oklahoma\u2014submitted waiver applications and have since withdrawn their applications. Massachusetts and Vermont both have submitted applications and received notification from the Centers for Medicare & Medicaid Services (CMS) that their applications were incomplete. It does not appear that either state has modified its application in response to the notifications as of the date of this report.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R44760", "sha1": "b2a9b9745d23812c572e728b288f05ab63a8eb99", "filename": "files/20180328_R44760_b2a9b9745d23812c572e728b288f05ab63a8eb99.html", "images": {} }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R44760", "sha1": "48d302c6331104c17c53d55166c3444d5e2e0bcc", "filename": "files/20180328_R44760_48d302c6331104c17c53d55166c3444d5e2e0bcc.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4790, "name": "Private Health Insurance" } ] }, { "source": "EveryCRSReport.com", "id": 573925, "date": "2017-10-10", "retrieved": "2017-10-17T14:20:12.929518", "title": "State Innovation Waivers: Frequently Asked Questions", "summary": "Section 1332 of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) provides states with the option to waive specified requirements of the ACA. In the absence of these requirements, the state is to implement its own plan to provide health insurance coverage to state residents that meets the ACA\u2019s terms. \nUnder a state innovation waiver, a state can apply to waive ACA requirements related to qualified health plans, health insurance exchanges, premium tax credits, cost-sharing subsidies, the individual mandate, and the employer mandate. The state can apply to waive any or all of these requirements, in part or in their entirety.\nTo obtain approval for a waiver application, a state must show that the plan it will implement in the absence of the waived provision(s) meets certain requirements. The state\u2019s plan must ensure that as many state residents have health insurance coverage under the plan as would have had coverage absent the waiver, and the coverage must be as affordable and comprehensive as it would have been absent the waiver. Additionally, the state\u2019s plan cannot increase the federal deficit. \nThe Secretary of the Department of Health and Human Services (HHS) and the Secretary of the Treasury share responsibility for reviewing state innovation waiver applications and deciding whether to approve applications. The earliest a state innovation waiver could have gone into effect was January 1, 2017. As of the date of this report, Alaska, Hawaii, and Minnesota are the only states with approved state innovation waivers. Hawaii\u2019s waiver is approved for calendar years (CY) 2017 through 2021; Alaska\u2019s and Minnesota\u2019s waivers are approved for CY2018-CY2022. Five other states\u2014California, Iowa, Oklahoma, Oregon, and Vermont\u2014have submitted waiver applications. California and Oklahoma have since withdrawn their applications, and the other state applications are pending.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R44760", "sha1": "2b1beacab13557616789c578487281638891944a", "filename": "files/20171010_R44760_2b1beacab13557616789c578487281638891944a.html", "images": {} }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R44760", "sha1": "286207a93d38d47fe48f3c8ad2bcd09103d39d26", "filename": "files/20171010_R44760_286207a93d38d47fe48f3c8ad2bcd09103d39d26.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4790, "name": "Private Health Insurance" } ] }, { "source": "EveryCRSReport.com", "id": 463594, "date": "2017-08-28", "retrieved": "2017-10-02T22:38:14.469312", "title": "State Innovation Waivers: Frequently Asked Questions", "summary": "Section 1332 of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) provides states with the option to waive specified requirements of the ACA. In the absence of these requirements, the state is to implement its own plan to provide health insurance coverage to state residents that meets the ACA\u2019s terms. \nUnder a state innovation waiver, a state can apply to waive ACA requirements related to qualified health plans, health insurance exchanges, premium tax credits, cost-sharing subsidies, the individual mandate, and the employer mandate. The state can apply to waive any or all of these requirements, in part or in their entirety.\nTo obtain approval for a waiver application, a state must show that the plan it will implement in the absence of the waived provision(s) meets certain requirements. The state\u2019s plan must ensure that as many state residents have health insurance coverage under the plan as would have had coverage absent the waiver, and the coverage must be as affordable and comprehensive as it would have been absent the waiver. Additionally, the state\u2019s plan cannot increase the federal deficit. \nThe Secretary of the Department of Health and Human Services (HHS) and the Secretary of the Treasury share responsibility for reviewing state innovation waiver applications and deciding whether to approve applications. The earliest a state innovation waiver could have gone into effect was January 1, 2017. As of the date of this report, Alaska and Hawaii are the only states with approved state innovation waivers. Four other states\u2014California, Minnesota, Oklahoma, and Vermont\u2014have submitted waiver applications. California has since withdrawn its application, and Minnesota\u2019s, Oklahoma\u2019s, and Vermont\u2019s applications are pending.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R44760", "sha1": "76106182238e763c01bb04bcdaf104fd15f05484", "filename": "files/20170828_R44760_76106182238e763c01bb04bcdaf104fd15f05484.html", "images": {} }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R44760", "sha1": "bf1822c316668a1ff5fbb7cbc87ba8696db7f37f", "filename": "files/20170828_R44760_bf1822c316668a1ff5fbb7cbc87ba8696db7f37f.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4790, "name": "Private Health Insurance" } ] }, { "source": "EveryCRSReport.com", "id": 463370, "date": "2017-08-17", "retrieved": "2017-08-21T14:17:16.076357", "title": "State Innovation Waivers: Frequently Asked Questions", "summary": "Section 1332 of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) provides states with the option to waive specified requirements of the ACA. In the absence of these requirements, the state is to implement its own plan to provide health insurance coverage to state residents that meets the ACA\u2019s terms. \nUnder a state innovation waiver, a state can apply to waive ACA requirements related to qualified health plans, health insurance exchanges, premium tax credits, cost-sharing subsidies, the individual mandate, and the employer mandate. The state can apply to waive any or all of these requirements, in part or in their entirety.\nTo obtain approval for a waiver application, a state must show that the plan it will implement in the absence of the waived provision(s) meets certain requirements. The state\u2019s plan must ensure that as many state residents have health insurance coverage under the plan as would have had coverage absent the waiver, and the coverage must be as affordable and comprehensive as it would have been absent the waiver. Additionally, the state\u2019s plan cannot increase the federal deficit. \nThe Secretary of the Department of Health and Human Services (HHS) and the Secretary of the Treasury share responsibility for reviewing state innovation waiver applications and deciding whether to approve applications. The earliest a state innovation waiver could have gone into effect was January 1, 2017. As of the date of this report, Alaska and Hawaii are the only states with approved state innovation waivers. Three other states\u2014California, Minnesota, and Vermont\u2014have submitted waiver applications. California has since withdrawn its application, and Minnesota\u2019s and Vermont\u2019s applications are pending.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R44760", "sha1": "cece6d4da3b52d42292bf3999ec0f0d66d4bbf4b", "filename": "files/20170817_R44760_cece6d4da3b52d42292bf3999ec0f0d66d4bbf4b.html", "images": {} }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R44760", "sha1": "cf8f83ccd4fe85ddd2f4d04388fcc2df6e84f1aa", "filename": "files/20170817_R44760_cf8f83ccd4fe85ddd2f4d04388fcc2df6e84f1aa.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4790, "name": "Private Health Insurance" } ] }, { "source": "EveryCRSReport.com", "id": 458862, "date": "2017-02-08", "retrieved": "2017-02-15T21:41:48.459283", "title": "State Innovation Waivers: Frequently Asked Questions", "summary": "Section 1332 of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) provides states with the option to waive specified requirements of the ACA. In the absence of these requirements, the state is to implement its own plan to provide health insurance coverage to state residents that meets the ACA\u2019s terms. \nUnder a state innovation waiver, a state can apply to waive ACA requirements related to qualified health plans, health insurance exchanges, premium tax credits, cost-sharing subsidies, the individual mandate, and the employer mandate. The state can apply to waive any or all of these requirements, in part or in their entirety.\nTo obtain approval for a waiver application, a state must show that the plan it will implement in the absence of the waived provision(s) meets certain requirements. The state\u2019s plan must ensure that as many state residents have health insurance coverage under the plan as would have had coverage absent the waiver, and the coverage must be as affordable and comprehensive as it would have been absent the waiver. Additionally, the state\u2019s plan cannot increase the federal deficit. \nThe Secretary of the Department of Health and Human Services (HHS) and the Secretary of the Treasury share responsibility for reviewing state innovation waiver applications and deciding whether to approve applications. The earliest a state innovation waiver could go into effect was January 1, 2017. As of the date of this report, Hawaii is the only state with an approved state innovation waiver. Three other states\u2014Alaska, California, and Vermont\u2014have submitted waiver applications. California has since withdrawn its application, and the Secretaries have not yet issued a decision on Alaska\u2019s or Vermont\u2019s application.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R44760", "sha1": "cc5d447a3d480952c471eccdd0742e29b27a671a", "filename": "files/20170208_R44760_cc5d447a3d480952c471eccdd0742e29b27a671a.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R44760", "sha1": "d9b8120c623a530c0dd4d05b3b852db3ee9fa314", "filename": "files/20170208_R44760_d9b8120c623a530c0dd4d05b3b852db3ee9fa314.pdf", "images": null } ], "topics": [ { "source": "IBCList", "id": 4790, "name": "Private Health Insurance" } ] } ], "topics": [ "Health Policy" ] }