CMS releases resources for states to apply for 1332 waivers to ignore parts of ACA

Seema Verma
CMS' new templates and resources are part of a larger effort to entice states to apply for the waivers to ignore parts of Obamacare. (HIMSS)

The Centers for Medicare & Medicaid Services (CMS) released new templates and other resources to help states apply for Section 1332 waivers under the Affordable Care Act (ACA).

The resources include an updated checklist of requirements needed to get a waiver, which waives certain requirements under the ACA, and templates to help states navigate the process.

“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,” said CMS Administrator Seema Verma in a statement.

Free Daily Newsletter

Like this story? Subscribe to FierceHealthcare!

The healthcare sector remains in flux as policy, regulation, technology and trends shape the market. FierceHealthcare subscribers rely on our suite of newsletters as their must-read source for the latest news, analysis and data impacting their world. Sign up today to get healthcare news and updates delivered to your inbox and read on the go.

Verma said the resources can help reduce “guesswork” when filling out applications for the waivers.

States can also use the templates to “identify areas of flexibility and variation,” CMS said. “For example, states are free to combine multiple waiver concepts or come up with their own waiver ideas.”

RELATED: CMS seeking ideas for new ACA innovation waiver concepts

So far, CMS has approved seven waivers, all of which focus on using federal tax credit funds to help state reinsurance programs, according to a July 10 report from the Kaiser Family Foundation.

The resources are the latest effort by CMS to entice greater participation in 1332. Back in October, the agency released a controversial policy that expanded what ACA requirements could be waived under Section 1332.

The policy walks back a 2015 guidance that restricted states to strict guardrails that include ensuring any waiver doesn’t cause the number of people with comprehensive and affordable coverage to decrease. The October guidance said short-term and association health plans can now be considered as coverage when determining whether a waiver meets the law's requirements. However, such plans do not offer as many benefits as a plan sold on the ACA's exchanges.

The Trump administration has tried to expand the use of such plans they describe as a cheaper alternative to the ACA marketplaces but critics say are a way to erode the law’s exchanges.

RELATED: States trying to avoid innovation waivers to tweak ACA exchanges, experts say

The Government Accountability Office (GAO) said in a legal opinion released by congressional Democrats Monday that the October guidance was in fact a rule.

Therefore, the rule is subject to the Congressional Review Act, meaning it must be submitted to both chambers of Congress and the U.S. Comptroller General before it goes into effect, according to the GAO opinion. Congress can overrule a regulation if both the House and Senate agree to a joint resolution under the act, which is unlikely to happen in the GOP-controlled Senate.

Congressional Democrats requested that the GAO look into the legality of the CMS guidance. CMS did not immediately return a request for comment as of press time on the GAO opinion.

Suggested Articles

The Trump administration has announced it would reject Utah's plan to cap expanded Medicaid enrollment while still earning full federal funds.

Canadian officials got an earful from the healthcare industry over the U.S. proposal to import drugs from the country.

A new study takes a look at how the U.S. stacks up to other developed countries on healthcare and social spending.