State Roles Using 1332 Health Waivers

Alaska

HB 374 of 2016

AK H 57 of 2017

Enacted into law; signed as Ch. 5, 7/18/2016
 

Enacted into law; signed as Ch. 1, 6/30/2017

Waiver Filed 12/29/2016

Approved 7/11/17

Reenacts Sec. 21.96.120. Waiver for state innovation, also referencing reinsurance and state high risk program. "The director may apply to the United States Secretary of Health and Human Services under 42 U.S.C. 18052 for a waiver of applicable provisions of P.L. 111-148 (Patient Protection and Affordable Care Act) with respect to health insurance coverage in the state for a plan year beginning on or after January 1, 2017. The director may implement a state plan meeting the waiver requirements in a manner consistent with state and federal law and as approved by the United States Secretary of Health and Human Services." Effective date: 7/18/2016..

HB 57, the FY 2018 state budget appropriates $55,000,000 from the Alaska comprehensive health insurance fund to the division of insurance, for the 2017 reinsurance program, authorized through June 2023.; funds ’’are contingent on federal approval of Alaska's Section 1332 waiver."

Waiver Filed to reimplement the Alaska Reinsurance Program (ARP) - Alaska Section 1332 State Innovation Waiver. The HHS response 1/17/2017 indicated the application was complete but additional state legislation would be needed to appropriate funds for the proposed program. Letter from Secretary Burwell to Governor Walker. |

• CMS Approval letter July 2017 

Arkansas

S 828 of 2015

H 1271 of 2017 

Engrossed; 3/5/2015; did not pass; adjourned 

2017 did not pass

Creates the Arkansas Health Insurance Innovation Act of 2015. Declares an emergency. The purpose of this measure is to encourage the executive and legislative branches to explore, develop, and facilitate innovative approaches to improving access to, affordability, and quality of comprehensive health insurance coverage and health care.

(2017) Creates the Arkansas Health Insurance Innovation Act of 2017.

California

S 10 of 2016

Passed Senate & Assembly;
Enacted into law; signed 6/10/2016 as Chapter 22 of 2016

--------------
Waiver filed Sept. 2016

California - not enacted

S 1364 of 2016
 

A 417 of 2017

 Did not pass; adjourned 2016

Passed Assembly 5/11/2017
 

S 1364: Declares the intent of the Legislature to enact legislation that would create a competitive marketplace for health care coverage consistent with the State Innovation Waiver requirements.

Changes the name of the Small Business Health Options Program (SHOP) to Covered California for Small Business. The Exchange shall apply to the HHS for a 1332 waiver of Section 100501 in order to allow persons otherwise not able to obtain coverage by reason of immigration status through the Exchange to obtain coverage from the Exchange.

CO H 2 of 2016

Filed 10/26/15; failed; Withdrawn from further consideration.

(H 2) Concerns a requirement that the state apply for a waiver of requirements of the federal ACA to allow employers to provide contributions to employees to purchase individual health care coverage in lieu of offering employer-sponsored group health care coverage. Requires an optional program for employers to share health care coverage costs with their employees. Provides for minimum premium amounts.

Georgia

H 1160 of 2016

Filed 3/16/16; Did not pass; adjourned 

Restricts involvement with health reform and requires legislative notification before the submission of waivers pursuant to Section 1332 of the ACA. Notification must “be by general Act or joint resolution of the General Assembly. Title includes “Relates to medical assistance generally.”

Hawaii

H 576 of 2015

S 2775 of 2016

S 1341 (did not pass; see above)

Passed House & Senate; enacted into law; signed 7/1/15 as Act 184.

S 2775 Enacted into law; signed 4/24/2016 as Act 13

Waiver filed 2016; approved 12/30/2016

Provides resources to develop a waiver from provisions of the ACA. Appropriates funds. Relates to a plan for coverage that is at least as comprehensive as required by the federal act, provides coverage and cost-sharing protections that are at least as affordable under the federal act, makes health insurance coverage available to as many residents as under the federal act, is budget-neutral for the federal government and complies with public notice requirements.

> S 2775 provides for alignment of the Affordable Care Act with the Hawaii Prepaid Health Care Act's requirements with three provisions as approved Dec. 2015: (1) ''Maintain access to affordable health insurance coverage for individuals via the state-based exchange utilizing the federal platform; (2) Align the Affordable Care Act with the Hawaii Prepaid Health Care Act's requirements for private employers to the extent allowable; and (3) Waive the Affordable Care Act Small Business Health Options Program and its requirements for the small business marketplace, including the employee choice provision.''

• WAIVER Documents: Hawaii Section 1332 State Innovation Waiver
• Letter from HHS to Hawaii on State 1332 State Innovation Waiver  | Approved 1332 waiver for Hawai’i
• Section 1332 Hawaii Comments- as submitted/posted through deadline of Oct 21, 2016

Idaho

(2018 legislation;

Waiver draft application pending state legislative action.

See description in 2018 - Table 1 Idaho has a draft 1332 waiver proposal subject to passage of state legislation in 2018. (Released 11/1/2017)

The goals are to:
“1. Increase overall participation in Idaho’s individual health insurance market.
2. Provide affordable coverage options to working Idaho households with incomes below 100% of the Federal Poverty Level (FPL) who are U.S. citizens not eligible for Medicaid, through the same mechanism that lawfully-present aliens currently obtain affordable coverage.
3. In conjunction with Idaho’s proposed Section 1115 Medicaid Waiver and Idaho Individual High Risk Pool (enacted 2017), stabilize and decrease the cost of insurance premiums in the individual health insurance market.

The Waiver will extend APTC and CSR eligibility to those working citizens who file federal income tax returns with income below 100% FPL . These individuals and families, expected to be around 22,000 lives, will qualify for APTC to the same extent as those with incomes of 100%  FPL: APTC will offset premium in excess of 2% of countable income. These Idahoans will also qualify for CSRs when enrolled in a silver plan through the exchange, which will provide cost sharing at a 94% actuarial value.”

• Published for public comment, 11/1/2017; Public comment ends 12/15/2017; planned submission to CMS 1/5/2018; proposed state legislation authorizing 1332 and 1115 enacted and signed April 2018; ideally, CMS grants waiver May 2018.

Iowa

(Legislation not specified)

Waiver draft submitted to CMS, 8/21/2017

Withdrawn 10/23/2017
 

Iowa has proposed a 1332 waiver via executive branch initiative only.

The Iowa Stopgap Measure "is a short-term solution to bring stability for Iowans dealing with the effects of the collapsing individual health insurance market due to the Affordable Care Act (ACA).  Without the Iowa Stopgap Measure, 20,000 more Iowans will likely be forced to go uninsured due to skyrocketing premium costs under the ACA according to the economic and actuarial analysis."
      It includes provisions for: 1) A single, standard plan available to every eligible Iowa consumer from each participating carrier, 2) Flat, per-member per-month premium credits based on age and income, and 3) A reinsurance program to support high-cost claimants. 

• Iowa state waiver documents: 1332 Iowa waiver web page by the Dept. of Insurance |   Economic and Actuarial Analysis - Aug. 9, 2017  |  Iowa video description - Aug. 2017 |  Iowa 1332 submitted application - August 21, 2017. (192 pp-PDF)

  CMS correspondence: Letter of Preliminary Determination of Completeness -Sept. 19, 2017

• Waiver Withdrawn: “Unfortunately, it now appears Obamacare’s waiver rules are as inflexible as the law itself,” Gov. Reynolds said at an Oct. 23 news conference in Des Moines. “I’m extremely disappointed.” Iowa wanted to create a state-run system for 2018 that its insurance commissioner said would lower premiums for most of the 72,000 residents of the state who currently have Obamacare health plans, including 28,000 who earn too much to get subsidies to help with the cost.
• Analysis: Iowa Waiver Application Presents Crucial Decision Point For Administration. "If CMS approves Iowa’s 1332 waiver application rewriting parts of the ACA, other states unhappy with the law will surely follow Iowa’s example.  (Excerpt) Reallocating Cost-Sharing and Premium Assistance: This proposal would abolish cost-sharing reduction payments for low-income enrollees; it would reallocate the funds that would otherwise have been devoted to reducing cost sharing and providing premium assistance for lower-income marketplace enrollees to provide premium assistance for all individual market enrollees, regardless of income. Because the federal exchange, which has served Iowa, can only administer tax credits according to the schedules set out in the ACA, Iowa is also proposing to establish its own system for determining eligibility for premium credits and for paying them to insurers." Posted at Health Affairs by Timothy Jost, JD, 8/24/2017.

Kentucky

H 242 of 2017

Enacted into law; Signed 3/21/2017

Authorizes the Department of Insurance to apply for a state 1332 innovation waiver under the ACA and implement any state plan proposed under an approved waiver. Requires final approval of a state plan by vote of the legislature. Also establishes the (renamed) Division of Insurance Product Regulation and the Division of Administrative Services; as well as renaming the Division of Consumer Protection.

Maine 

S 221 of 2017

Enacted; signed as Public Law No. 124, 6/2/2017 

Waiver filed 5/9/2018

Waiver approved by CMS, July 30, 2018
 

*NEW*

Amended the Maine Guaranteed Access Reinsurance Association Act; provides that the superintendent may order the association to resume operations in accordance with the revised plan if the revised plan is likely to provide significant benefit to the State's health insurance market. "the superintendent may develop a proposal for an innovation waiver under Section 1332."

On  May 9, 2018, Maine submitted a waiver application to the federal government seeking funding for a state-based reinsurance program.

On July 30, 2018, CMS issued a letter to Maine that the State 1332 waiver under ACA was approved, subject to the usual state acceptance of the specific terms and conditions (STCs) in the letter. 

Maine

S 289 of 2015

Seeks to establish the "Maine Health Care Plan" a universal, single-payer style plan "to provide security through high-quality, affordable health care for the people of the state and to include federal funds to the maximum extent allowable under federal law and waivers from federal law. The plan would become effective and binding upon the approval of a state waiver ...  pursuant to Section 1332."

Maryland
H 1795 &
S 1267; S 387 &
H 1782 of 2018

Enacted & signed, 4/2018

Waiver Approved 8/22/2018

Authorizes receiving federal funds and state funding for reinsurance in the individual market through the health care access program and shall be contingent on the CMS/HHS approving a waiver under section 1332 of the affordable care act.

• LATEST APPROVAL: HHS and Treasury completed final review and approval of Maryland's reinsurance plan, announced on Aug. 22, 2018.
  Maryland state officials described their new program: "Maryland will use about $365 million that health insurance companies no longer have to pay the federal government due to last year’s changes to the federal tax code. Maryland also will receive federal matching money. Maryland’s program will be valued at about $462 million in its first year, the governor’s office said. The money will create a pool to provide funding for the biggest claims in the individual market. The program will become active this year and run through 2020, with the potential to be extended through 2023."

H 910 of 2017

Did not pass, withdrawn 

Massachusetts

H 3829 of 2015

H 3838 (Governor's)

Passed House and Senate; became law as Chapter 119 of 2015.

Waiver draft 2016

Waiver posted for public comment 7/24/2017

Mass. Chapter 119, sec. 20 of the Acts of 2015. Authorizes state agency "to make applications to the United States Secretary of HHS to waive any applicable provisions of the (ACA) and to implement the state plans of any such waiver in a manner consistent with applicable state and federal laws."

> Separate provision requires the Connector (exchange) Board to submit a report to the Legislature at least 90 days before, and within 10 days after, submitting an application pursuant to Section 1332 of the Patient Protection and Affordable Care Act, to the federal government. The report is to include the intent and purpose of the proposed application and any changes to state law. > Governor Baker vetoed this section 77, and filed an amendment, in H 3838, to reduce the 90 days to 30 days.

Waiver Documents

• Massachusetts is exploring a multiple reforms, 

  Under Section 1332, Massachusetts proposes to use federal pass through money to provide advance payments to insurers operating cost-sharing reduction plans if federal CSR payments are halted. (or provide an alternative stabilization mechanism.)

• Require employers who do not insure their employees to make payments to the state – Massachusetts’ employer responsibility laws already follow a different structure than ACA’s and would include smaller employers; and
• administer small business tax credits, coordinating credits with other Massachusetts small group insurance initiatives.

• A separate section of the Affordable Care Act (Section 1321(e)) authorizes (only) Massachusetts, which offered state-subsidized coverage through an exchange marketplace enacted in 2006, four years before the ACA became law, to continue several of its earlier initiatives. The state proposes to continue allowing group plans to use some rating factors not otherwise allowable, using Section 1321(e) authority.  This provision could also include modifications to the federal risk adjustment rules. 

  Waiver Documents

• Draft proposal - "Requests for State Flexibility to Support Commercial Insurance Market Stability and Reforms" July 24, 2017  (51 pp, PDF)
• Public comment meeting materials - July 2017
• Detail on Premium Stabilization Fund Request (waiving CSR payments) - June-Sept, 2017

Minnesota

S 1458 of 2015

Enacted into law; signed 5/22/2015

Establishes a Health Care Financing Task Force that will consider "opportunities, including alternatives to MNsure (Medicaid), options under section 1332 of the ACA and options under a section 1115 waiver." 

[See similar H 1181, H 1939, S 813 & S 1275, not enacted]

H 5  of 2017

Enacted; signed into law 4/3/2017 as Chapter No. 13

Waiver filed with HHS -5/5/2017
Waiver approved - 9/22/2017

Creates the Minnesota premium security plan as a state-based reinsurance program administered by the Minnesota Comprehensive Health Association; establishes a legislative working group; regulates health care provider system access; modifies premium subsidy program provisions.

Minnesota filed waiver Application:

• Minnesota Section 1332 State Innovation Waiver [PDF, 154 pp; 6MB], Filed May 5, 2017

• Public Comment on Waiver [PDF]  submitted through July 30, 2017 | Notice of Completeness [PDF]  June 30, 2017

• Approval: HHS/Treasury Letter [PDF, 316KB]  - Sept. 22, 2017

MN S 800 of 2017

MN S 2060 &
S 2089 &
H 2209 &
 S 2163
---------------

H 358 & H 488 of 2017
S 219 & S 220 &
S 223 of 2017

Filed 2015; Did not pass; adjourned 

Filed 1/19/2017; pending

Seeks to establish the "Minnesota Health Plan" a universal, single-payer style plan guaranteeing that all necessary health care is available and affordable for every Minnesotan." All federal funding received by Minnesota including the premium subsidies under the ACA as authorized by the section 1332 state innovation waiver, is appropriated to the Plan.

MN H 2405 &

H 2491 &

S 2541 &

S 2564

Filed 3/8/2016;

Did not pass; adjourned 

The commissioner shall apply for an innovation waiver under section 1332 of the Affordable Care Act, or any other applicable federal waiver to allow persons eligible for MinnesotaCare the option of declining MinnesotaCare coverage and instead accessing advanced premium tax credits and cost-sharing reductions through the purchase of qualified health plans through MNsure

Missouri
H 2539 of 2018
 

SCR 25 of 2017

Filed 2/27/2018; pending

4/27/2017;
Did not pass

The director shall apply to the Secretary of Health and Human Services under 42 U.S.C. Section 18052 for a state innovation waiver to implement the Missouri reinsurance plan for benefit years beginning January 1, 2019, and future years, to maximize federal funding for the plan.

Non-statutory resolution  to establish a state innovation waiver task force to develop a health care reform plan that meets the requirements for obtaining a state innovation waiver: 

MO H 780 of 2017

Establishes a state innovation waiver task force to develop a health care reform plan for applying for a state innovation waiver per section 1332 of the federal act. Includes examining the feasibility of options for providing affordable insurance coverage for uninsured and underinsured individuals in Missouri that include innovations to the State's existing Medicaid program;

Montana
H 652 of 2017

Nevada
AB 374 of 2017

New Hampshire

H 469

Enacted; signed into law 7/10/2017 as Ch. 2017-221

Waiver draft posted for comment 

Relates to the authority of the insurance department on federal health care reform. The intent ''is to preserve the state's status as the primary regulator of the business of insurance within New Hampshire and the constitutional integrity and sovereignty of the state of New Hampshire under the Tenth Amendment.'' The commissioner may request that the board of directors of the association develop a plan of operation to support the affordability of health insurance in the individual market. The proposal may include resumption of the risk adjustment program, reopening of the high risk pool, creation and operation of a reinsurance program, or other such program. The commissioner is authorized to submit an application on behalf of the state to the US Treasury, and if required, to the US Secretary of Health and Human Services, to waive certain provisions of the Act, as provided in section 1332 of the Act, or any other applicable waiver provision. Establishes a continuous quality improvement program for pharmacies; also authorizes vaccines to be administered by pharmacists.

• NH 1332 Waiver Application -(Text form PDF, 17 pp.) "New Hampshire’s Proposal to Waive Certain Provisions of the Patient Protection and Affordable Care Act Under Section 1332 of the Act, Waivers for State Innovation" - 
• ^{This waiver would "implement a state-operated reinsurance program for 2018 and subsequent years. The state would use the interest income from assessments on carriers under NH RSA 404-G to fund the operations of the reinsurance program. The state-based reinsurance program would mitigate rate increases in the New Hampshire individual health insurance market and, as a result, would limit the amount of premium tax credits the federal government is responsible for providing to New Hampshire residents. The benefits of the state-based reinsurance program would be shared by the entire individual health insurance market regardless of income, age, race and ethnic group, or any other demographic characteristic." (p. 3) The reinsurance mechanism, along with the waiver, is estimated to decrease premium rates by approximately 7.3% from what they would have been absent the mechanism and waiver.  As permitted by the ACA, New Hampshire proposes to apply the federal funding that would be paid to New Hampshire consumers absent the state-based reinsurance program. This funding could be combined with ongoing broad-based assessments under NH RSA 404-G to further stabilize the individual market.(p. 6)} 

New Jersey
S 1878 of 2018

Filed 2/8/2018; 
Signed into law, 5/30/2018

Waiver approved by CMS/Treasury,
8/16/2018

*NEW*

Relates to the New Jersey Health Insurance Premium Security Act; establishes health insurance reinsurance plan; relates to stabilizing or reduce premiums in the individual health insurance market by providing reinsurance payments to health insurance carriers with respect to claims for eligible individuals.
    A separate new law to create a state individual mandate (S1877) would require individuals who work for small businesses to enroll in coverage that meets small-group mandates in order to avoid the state's penalty for not having qualifying insurance.

• HHS and Treasury completed preliminary review of New Jersey’s 1332 state innovation waiver application and determined that it is complete. Read the HHS letter of July 13, 2018.
• HHS and Treasury on Aug 16, 2018 approved New Jersey’s State Innovation Waiver application under section 1332. New Jersey’s application seeks to implement the New Jersey Health Insurance Premium Security Plan for 2019 through 2023. The CMS approval states, "As a result of the waiver approval, more individuals in New Jersey may have coverage, individuals will see lower premiums, and the state will receive pass-through funding to help offset a substantial portion of State costs for the state-operated reinsurance program. New Jersey  is seeking to waive section 1312(c)(1) of the ACA to the extent that it would otherwise require excluding total expected state reinsurance payments when establishing the market-wide index rate. This approval of New Jersey’s waiver application is effective for January 1, 2019 through December 31, 2023.

New Jersey
A 4945 of 2017

New Mexico

SJM 2

Filed 2015; passed Senate; Did not pass; adjourned 

Resolution requests the superintendent of insurance to "convene an innovation waiver working group composed of experts in health care delivery, policy and finance as well as related areas;  to analyze the potential, under the auspices of a federal innovation waiver, for designing a comprehensive, sustainable health care system that: A.) addresses the effects of the lack of health insurance, unaffordable health coverage, disparities in access to health care and uncompensated care on New Mexicans; B.) provides for the collection of data and the examination of variations in health care utilization; and C. bends the health care cost curve in the state."

New York
A 4738 of 2017

S 4371 of 2017

S 4840 of 2017

Ohio

H 64 of 2015

Enacted into law; signed 6/30/2015, as Session Law No. 2015-11

Waiver filed 3/30/2018

Requires the superintendent of insurance to apply to the federal government "for an innovative waiver regarding health insurance coverage in this state as authorized by section 1332 ." It "shall include in the application a request for waivers of the employer and individual mandates." and shall provide for the establishment of a system that provides access to affordable health insurance coverage for the residents.  (Budget Sec. 3901.052).

Waiver Documents - filed March 30, 2018
On March 30, 2018, Gov. Kasich filed the Ohio 1332 waiver with HHS.  (The first to be addressed to Sec. Azar) It completely eliminates the "individual manade" requiring heath insurance coverage, a minor legal step now that federal law eliminated the financial penalty. : 

Oklahoma

S 1386 of 2016

H 2406 of 2017

Filed 1/2016; Enacted into law; signed 5/16/2016

S 1386, Relates to health insurance; creates a section 1332 State Innovation Waiver; allows for multiple waiver submissions. Establishes procedures for development. Requires entities to submit information for approval. Includes "for the purpose of creating Oklahoma health insurance products that improve health and health care quality while controlling costs."  Authorizes the Insurance Department to review health insurance market after waiver implementation.

H 2406 Enacted into law; signed 6/6/2017

Waiver filed with HHS & Treasury 8/16/2017

H 2406, authorizing the establishment of the Oklahoma Individual Health Insurance Market Stabilization Program, the authority for the State to pursue 1332 waivers as well as receive Federal funds, a governing Board of Directors appointed by the Oklahoma Insurance Commissioner, a revenue source through assessments on Oklahoma health insurers, and administrative policies and processes overseeing the State’s reinsurance program.

Oklahoma proposes to implement a reinsurance program beginning 1/1/2018 and continuing into future years in order to rapidly reduce premiums for consumers purchasing coverage on the individual market. The State plans to utilize Federal pass-through funds, coupled with amounts generated by an assessment on health insurers (see Attachment A for House Bill 2406 which defines the insurers to be assessed), to fully or partially reimburse qualified insurers for the claims experience of their high-cost enrollees. The high-cost enrollees are defined as those whose total claims experience in a one year period reaches $15,000, as the State’s attachment point. The State plans to reimburse plans for 80% of the enrollees’ costs between the attachment point and the cap of $400,000. Enrollee costs above the cap, as well as the administration of all claims, will be the responsibility of the insurer. Enrollee costs are determined on an annual, calendar year basis corresponding to the plan year." (Waiver, p 13)

Filed Application to HHS and Treasury:

• Oklahoma Section 1332 State Innovation Waiver   - Filed Aug. 16, 2017
• Correspondence: Notice of Preliminary Determination of Completeness [PDF, 463KB] - Aug. 24, 2017
• News: Oklahoma withdrew its waiver request saying the federal administration had not approved the waiver despite earlier signaling it would do so by Sept. 25 (see related story). Oklahoma residents will now face 34 percent higher premiums, according to the state.
  Former CCIIO head Joel Ario noted in Health Affairs, ^{"Federal officials have yet to explain their abrupt change of course and likely will claim that they simply ran out of time. But those of us who have worked closely with the four states who have submitted reinsurance waivers know a different story. We know that two of those states--Alaska and Minnesota--have been approved for waivers closely resembling Oklahoma’s proposal: documenting the federal savings that accrue when state-based reinsurance programs cut premiums and reduce federal tax credit outlays, and then receiving those savings as a federal pass-through to partially offset the costs of the state reinsurance program,”  [posted 10/2/2017]}

Relates to insurance; seeking approval of a waiver provided by a 1332 State Innovation Waiver, authorizing federal funding to support market stabilization program payments.

Oregon

H 2391 of 2017
Statenet link: H 2391

H 2391 enacted into law 2017, 7/3/2017

Waiver filed 8/31/2017

Approved 10/19/2017 -*NEW*

This request seeks waiver of Section 1312(c)(1) under Section 1332 of the ACA for a period of five years beginning in the 2018 plan year to develop a state reinsurance program. This waiver will not affect any other provision of the ACA, but will result in a lower marketwide index rate, thereby lowering premiums and reducing federal payment of advance premium tax credits (APTC). Provides that ''The Department of Consumer and Business Services shall have sole authority to apply for a waiver for state innovation under 42 U.S.C. 18052." (same as Sec 1332)'

• Application: Oregon Section 1332 State Innovation Waiver filed 8/31/2017
• Approved: Approval notification, received 10/19/2017
  (Excerpt): "The Departments have determined that implementation of this reinsurance program will lower
  individual market premiums in the state and the premium tax credits (PTC) to which Oregon
  residents would have been entitled absent the waiver. These PTC savings will be passed through
  to the state to be used for implementation of the waiver plan." 
  Summary: "Oregon will reinsure 50 percent of claims, in excess of an attachment point to be determined, up to $1 million.

  Oregon is financing part of its program through a 0.3 percent tax on major medical premiums but projects that the program will reduce premiums by 7.5 percent in 2018, 7 percent in 2019, and 6.4 percent in 2027 compared to what premiums would have been without the waiver. The waiver approval does not state how much federal money will be passed through to Oregon from reduced federal payments for premium tax credits and cost-sharing reductions to assist in paying for the program." (By Tim Jost, Health Affairs 10/19/2017)

Public comment period, ends Oct 11, 2017  
Correspondence: Notice of Preliminary Determination of Completeness [PDF, 443KB] 

Rhode Island

RI H 5900

RI H 7381and
S 2824

Enacted into law; Signed 6/30/2015

1332 Waiver authorization.   [excerpt of text] 42-157-5. Regional purchasing, efficiencies, and innovation. To take advantage of economies of scale and to lower costs, the (state health) exchange is hereby authorized to pursue opportunities to jointly negotiate, procure or otherwise purchase exchange services with or partner with another state or multiple states and to pursue a Federal Affordable Care Act 1332 Waiver. 

[Also see RI H 7381, and RI S 2824, single-payer proposals; did not pass; adjourned]

RI S 831 of 2017

Pending; passed Senate 6/6/2017

RI H 6082 of 2017

Filed 4/6/2017; passed House, 6/14/2017

Would authorize the Rhode Island health benefit exchange to "shall" seek a waiver under Sec 1332 of the ACA to allow qualified small business owners and sole proprietors to purchase qualified health benefit plans offered by the exchange and not be forced into the individual market. This act would take effect upon passage, ''in an effort to reduce and/or eliminate the irreparable economic harm.''

South Carolina

H 3020

Sought to enact the ACA Anti-Commandeering Act; provides that a public official, officer, or employee of a public body must not participate in the establishment of a health insurance exchange or enforce or aid in the enforcement of the individual and employer health insurance mandates. It also provides, "nor does this act limit the South Carolina Department of Health and Human Services' ability to apply for, request, or otherwise develop innovation waivers as set forth in Section 1332 of the ACA."

South Dakota

S 50 of 2017

failed, 2/27/2017

Authorizes the submission of an application for a 1332 state innovation waiver regarding health insurance, including provisions for a market that provides access to affordable health insurance coverage for the residents of this state

Texas

SB 200 of 2015

Enacted into law; signed 6/17/2015 as Ch. 837

The Texas Health and Human Services Commission “shall develop and implement a comprehensive, coordinated operational plan to ensure a consistent approach across the major quality initiatives of the health and human services system for improving the quality of health care. (b) The operational plan developed under this section must include broad goals for the improvement of the quality of health care in this state, including health care services provided through Medicaid. (c) The operational plan under this section may evaluate: the Delivery System Reform Incentive Payment (DSRIP) program under the Texas Health Care Transformation and Quality Improvement Program waiver issued under Section 1115 of the federal Social Security Act (42 U.S.C. Section 1315), enhancing funding to disproportionate share hospitals in the state, Section 1332 of 42 U.S.C. Section 18052, enhancing uncompensated care pool payments to hospitals in the state under the Texas Health Care Transformation and Quality Improvement Program waiver issued under Section 1115...

Texas:
S 1406 of 2017

S 2087 of 2017

Filed 3/7/2017; Enacted into law, signed 6/15/2017, Ch. 106 of 2017

Filed 3/10/2017; Enacted into law; signed 6/12/2017, Ch. 765

Establishes that the commissioner of insurance may apply to and negotiate with the US HHS secretary to obtain a waiver under 42 U.S.C. Section 18052 for small employer health benefit plans of the actuarial value requirements and related levels of health plan coverage requirements imposed under the ACA .

Allows the establishment of a temporary health insurance risk pool to provide a temporary mechanism for maximizing available federal funding to assist residents of this state in obtaining access to quality health care at minimum cost to the public.

Sec. 1510.008. WAIVER. (a)The commissioner may apply to the United States secretary of health and human services: (1)under 42 U.S.C. Section 18052 for a waiver of applicable provisions of the Patient Protection and Affordable Care Act (Pub. L. No.A111-148) and any applicable regulations or guidance; or (2)under any applicable provision of federal law enacted on or after May 1, 2017, for a waiver of applicable provisions of any federal law, regulations, or guidance with respect to health insurance coverage consistent with Section 1510.003. (b)The commissioner may take any action the commissioner considers appropriate to make an application under this section. (c)The commissioner may implement a state plan that meets the requirements of a waiver granted in response to an application under Subsection (a) if the plan is: (1) consistent with state and federal law; and (2) approved by the United States secretary of health and human services. Sec.A1510.009.

Vermont

H 524

(See 2016 below)

Filed 1/6/2016; Enacted into law; signed Act 67, 2/29/2016.

Waiver filed with HHS and Treasury 6/9/2016

H 524 Directs the Commissioner of the State Health Access to seek a Section 1332 federal waiver that would permit state businesses to continuing purchasing State Health Benefit Exchange plans directly from the health insurance carriers.

• Application: Vermont Section 1332 State Innovation Waiver - Submitted March 15, 2016

• CMS: Vermont Notice of Preliminary Determination of Incompleteness - June 9, 2016

Vermont
H 875 of 2016

Enacted; signed into law 6/8/16

2017 appropriations bill; includes provision that the Secretary of Administration is required to "analyze the financial implications of expanding Dr. Dynasaur, the State's children's Medicaid and Children's Health Insurance Program, to all Vermont residents up to 26 years of age. The Secretary may contract with other individuals and entities as needed to provide actuarial services, economic modeling, and any other assistance the Secretary requires in carrying out the analysis, using "opportunities and challenges presented by federal law, including the Internal Revenue Code; Section 1332" of the ACA, Medicaid and SCHIP and by State tax law."

Vermont

H 88 of 2015

VT H 28 of 2017

Filed 1/22/15; did not pass; adjourned

Proposes to create a public health care coverage option, called Vermont Care, to be offered through the Vermont Health Benefit Exchange. State premium assistance would be available only for individuals enrolled in Vermont Care. The bill would remove health care from the list of topics on which public employees may bargain collectively and provide health coverage for those individuals through Vermont Care. The bill would enact an individual responsibility requirement to have health care coverage and establish a payroll tax. "On or before Jan. 1, 2016, the secretary of human services shall apply for a Waiver for State Innovation pursuant to Sec. 1332."

Filed 1/10/2017; pending 8/29/17

(H 28) Proposes to create a public option for health care coverage that would be available to all Vermont residents and employers and would be publicly funded. It would remove health insurance benefits from the provisions subject to bargaining for public employees who are subject to a collective bargaining agreement and instead specify that employees who wish to have health insurance coverage would be covered under the public option.

VT S 103 & H 447 of 2016

Did not pass; adjourned

H 447: Relates to establishing the Vermont Hospital Security Plan and Trust Fund from which a negotiated payment would be made to each hospital for health services provided. 

S 103: Relates to increasing exchange subsidies up to 400 percent of the federal poverty guideline for cost-sharing assistance and to developing a proposal for universal health care by 2018.

Washington
S 6488

Passed Senate; did not pass House; adjourned 2016

Directs the health care authority to apply for a 1332 federal innovation waiver to expand an employer-based coverage option with a portable health care account.

• "Section 1332 Waivers: Washington state's Market Stability Project" - fact sheet by the Washington Office of the Insurance Commissioner and Health Benefits Exchange. ^{(accessed 9/7/2017)}

Wisconsin
S 770

*NEW*

Passed Senate & House; signed 2/27/2018 as Act No. 138.

Waiver approvd 7/29/2018.
*NEW*

Establishes the Healthcare Stability Plan; with a program for reinsurance of health carriers (with a goal of controlling premium price increases); reallocates savings from the health insurer fee; authorizes use some funds ''for the state subsidy of reinsurance payments for the reinsurance program; in addition Federal funds referenced as ''All moneys received from the federal government for reinsurance for the purposes for which received.'' Authorizes a state request to the federal HHS for one or more waivers under 42 USC 18052 (sec. 1332) to implement the healthcare stability plan.  In addition, claims-based reinsurance, including a Medicaid savings program was enacted in 2017

On April 18, 2018, Wisconsin submitted a State Innovation Waiver application. The Departments (HHS, Labor, Treasury) determined that the application was complete on May 9, 2018. The Departments requested comments on Wisconsin’s Waiver as part of the federal public comment period, through June 8, 2018. The letter that CMS issued July 29 informs Wisconsin that the Waiver under section 1332 of the ACA is approved, subject to the state’s acceptance of the specific terms and conditions (STCs) in the letter.
Application: Wisconsin Section 1332 State Innovation Waiver.

HHS Correspondence: Notice of Preliminary Determination of Completeness [PDF, 455KB]    May 9, 2018