About the 1332 State Innovation Waiver Application Process
States have the option to seek a State Innovation Waiver under Section 1332 of the Affordable Care Act to pursue innovative strategies to provide high quality, affordable health care coverage while retaining the statute’s basic protections. The U.S. Department of Health and Human Services (HHS) and the U.S. Department of the Treasury are responsible for reviewing waiver applications.
States may submit State Innovation Waiver applications to firstname.lastname@example.org.
Public Input Process Prior to Submission of an Application
Prior to submitting a State Innovation Waiver application to HHS for review and consideration, a state must provide public notice and a comment period sufficient to ensure a meaningful level of public input on the application. During the public comment period, the state must conduct public hearings regarding the state’s application. In addition, a state with one or more federally recognized tribes within its borders must conduct a separate process for meaningful consultation with the tribes as part of the notice and comment process.
The final regulations specify what information needs to be included in an application for a State Innovation Waiver. Critical elements of that application include (but are not limited to):
- The list of provisions the state seeks to waive, including the rationale for the specific requests;
- Data, assumptions, targets, and other information sufficient to determine that the proposed waiver will provide coverage that is at least as comprehensive as would be provided absent the waiver, will provide coverage and cost sharing protections that keep care at least as affordable as would be provided absent the waiver, will provide coverage to at least a comparable number of residents as would be provided coverage absent the waiver, and will not increase the Federal deficit;
- Actuarial analyses and actuarial certifications to support State estimates that the waiver will comply with the comprehensive coverage requirement, the affordability requirement, and the scope of coverage requirement;
- A detailed 10-year budget plan that is deficit neutral to the Federal government;
- A detailed analysis of the impact of the waiver on health insurance coverage in the state;
- A description and copy of the enacted state legislation providing the state authority to implement the proposed waiver; and,
- A detailed plan as to how the state will implement the waiver, including a timeline.
The regulations provide more detail about each of the application elements and should be consulted carefully as states develop applications.
HHS may also request, or a state may propose, additional information to aid in the review of the application.
Application Review Process
Upon receipt of a State Innovation Waiver application, HHS and the Department of the Treasury (the Departments) will work with the state on the review and approval process. The Departments (in coordination with other agencies as applicable) will follow the process outlined below:
- The Departments will conduct a preliminary review within 45 days of submission to determine if the application is complete. Written notice will be provided to the state that the preliminary determination has been made. The written notice will either indicate that the application is complete or will identify elements missing from the application.
- The preliminary determination that the application was complete does not preclude a finding during the review process that a necessary element of the application is missing or insufficient.
- Following the preliminary determination that a state’s application is complete, the Departments will provide for a public notice and comment period.
The final decision of the Secretaries of HHS and the Treasury will be issued no later than 180 days after the determination that an application is complete.