Considerable uncertainty surrounds the potential scope of the “waivers for state innovation” authorized under the Affordable Care Act (ACA), which allow states to modify how they implement key elements of health reform beginning in 2017.  Also known as “1332 waivers” for the section of the ACA creating them, the waivers are attracting attention as a way states may pursue their own approaches to expand coverage, including alternatives that would represent a significant departure from the ACA’s standards and requirements.

Many aspects of the ACA, however, cannot be waived.  Moreover, the ACA establishes several conditions that states must satisfy if they diverge from ACA standards and requirements.  These conditions ensure that states using the ACA’s waiver authority continue to meet the overarching goals of health reform, such as extending access to affordable health coverage that provides a basic level of benefits.

In addition, section 1332 waiver authority doesn’t extend to Medicaid or the Children’s Health Insurance Program (CHIP).  If a state wants to change these programs at the same time that it changes how it implements health reform, it can simultaneously request approval of a Medicaid or CHIP demonstration project under section 1115 of the Social Security Act.  Section 1332 waivers aren’t themselves “super waivers” that give states sweeping new authority over Medicaid or CHIP (or Medicare), as some have suggested. 

This paper describes key elements of 1332 waivers, how states may use them, what conditions states must satisfy to receive federal approval, and how they interact with existing waiver authority related to other federal health programs.

 

CBPP – Understanding the Affordable Care Act’s State Innovation (“1332”) Waivers

Brookings – Why Section 1332 could solve the Obamacare impasse

Brookings – States are the Key to Both Strengthening and Replacing the Affordable Care Act

CBPP – Understanding the Affordable Care Act’s State Innovation (“1332”) Waivers

Commonwealth Fund – Innovation Waivers: An Opportunity for States to Pursue Their Own Brand of Health Reform

Commonwealth Fund – Innovation Waivers and the ACA: As Federal Officials Flesh Out Key Requirements for Modifying the Health Law, States Tread Slowly

PHNP – How far can we go with Sec. 1332 waivers?

Texas Insight – Texas Should Begin Preparing for its 2017 Block Grant Opportunity Now

Harvard School of Public Health – ACA waiver could be a ‘game-changer’

NCSL – Health Innovation Section 1332 Waivers State Legislation as of 2015

Huffington Post – ‘Innovation Waivers’ Allow States to Experiment, Try to Improve Upon ACA

Knox Mercury – States Can Create Alternatives to Obamacare

The Federalist – How To Opt Out Of Obamacare

FORBES – Kentucky Can’t Reform Medicaid Under Section 1332 Of Obamacare

Business Journal – Hawaii first state to seek waiver from parts of federal health care law

Houston Chronicle – New waiver to provide opportunity to expand health coverage, 2 lawmakers say

Families USA – How Could a 1332 Waiver Affect Medicaid and CHIP?

Families USA – Dispatch from NCSL Summit: 1332 Waivers a Hot Topic

Arkansas News – State senator to pursue new waiver for health care innovation

Arkansas Times – Arkansas Health Insurance Marketplace report examines 1332 waivers, potential tool for future reform

Community Catalyst – To 1332, or Not to 1332: That is the Question

Georgetown University – The ACA’s State Innovation Waivers: A Need for Transparency and a Role for Stakeholders

Star Tribune – Seize Minnesota’s chance to change and build on Affordable Care Act

Governing – With Innovation Waivers, States Can Go Their Own Way on Obamacare

AEI – The public option hidden in the Affordable Care Act

How Could a 1332 Waiver Affect Medicaid and CHIP?

Buying Into Medicaid: A Viable Path for Universal Coverage

State Single Payer And Medicaid Buy-In: A Look At California, New York, And Nevada