May 08, 2019
The Centers for Medicare & Medicaid Services (CMS) and the Department of the Treasury issued a Request for Information (RFI) asking for more ideas on innovative programs and waiver concepts that states could consider in developing a State Relief and Empowerment Waiver plan (also referred to as “Section 1332 waiver” or “State Innovation Waiver”).
The RFI comes after CMS and the Treasury issued guidance in October 2018 outlining how the Trump Administration interprets the 1332 waiver guardrails in the Affordable Care Act. The Trump Administration’s interpretation differed from that of the Obama Administration’s in several ways: focusing on the availability of coverage rather than the number of individuals covered; concentrating on the aggregate effects of a waiver rather than the effect on a population; and expanding the definition of coverage to include short-term, limited duration insurance plans and AHPs. At the same time, CMS released four waiver concepts to illustrate how states might take advantage of this flexibility. Since the October 2018 guidance and concepts were issued, few states have taken advantage of the relaxed guardrails. CMS has stated that the goal of the new RFI is to develop additional concepts that will allow states to take advantage of Section 1332 waivers. Comments for the RFI are due by July 2, 2019.