CMS is seeking feedback from industry stakeholders on new programs and concepts states could try under section 1332 waivers, otherwise known as “state innovation” waivers.
These waivers allow the Centers for Medicare & Medicaid Services to waive certain Affordable Care Act requirements to allow states to try out new initiatives within their insurance markets. The Department of Treasure is also signed on to the request for information (PDF).
In a blog post announcing the RFI, CMS Administrator Seema Verma wrote that these waivers offer states greater flexibility to tailor their ACA exchanges and plan oversight to the needs of their residents.
“Washington doesn’t have all the answers when it comes to our healthcare needs and, as experience with the [ACA] shows, when Washington imposes a one-size-fits-all approach on every state, any problems with the approach become nationwide problems,” Verma wrote.
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Late last year, CMS took steps to encourage more states to take advantage of these waivers. In October, the agency released new guidance that eased some of the requirements states would need to meet to qualify for a waiver.
About a month later, CMS also outlined four potential waiver concepts that states could try if they applied for a 1332 waiver. Under these models, states could create and contribute to accounts that help cover premiums and other healthcare costs, or implement high-risk pools in their markets.
In addition, the new waiver concepts would allow states to adjust the member eligibility requirements for ACA subsidies and update which plans qualify for subsidies.
In the blog post, Verma touted the first concept—the accounts for plan members—as the option likely to “hold the most promise” in addressing cost concerns with ACA plans.
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Verma said the agency is hoping that respondents to RFI will build on these ideas to devise additional options for section 1332 waivers. CMS is aiming to build a library of waiver concepts that states can consider if they want to reconfigure their ACA markets.
CMS is also looking for ways that section 1332 waivers could be used in tandem with section 1115 waivers in Medicaid, Verma said. Respondents are also invited to pitch waiver ideas that could be used in combination with other section 1332 waivers, or that gel with other regulatory permissions that CMS could offer.
“By taking advantage of a state relief and empowerment waiver, states can chart a new course toward more affordable healthcare choices,” Verma wrote.