HHS issues guidance on state 1332 waivers, sets rules preventing limited, expensive coverage

December 10, 2015

Beginning Jan. 1, 2017, states can request that the federal government waive basically every major coverage component of the ACA, including exchanges, benefit packages and the individual and employer mandates. In its 19-page final guidance on 1332 waivers, HHS states it would deny any proposals that would result in loss of coverage, especially to the most vulnerable populations such as low-income and elderly individuals, those with serious health issues or those susceptible to developing serious health issues. HHS will approve a waiver if it finds that it would provide coverage to a comparable number of residents of the state as would be provided coverage absent the waiver, would provide coverage that is at least as comprehensive and affordable as would be provided absent the waiver and would not increase the federal deficit. If the waiver is approved, the state may receive funding equal to the amount of forgone federal financial assistance that would have been provided to its residents pursuant to specified ACA programs, according to the guidance. Arkansas, California, Hawaii, Massachusetts, Minnesota, New Mexico and Rhode Island have already expressed some interest in seeking a 1332 waiver.