The Centers for Medicare & Medicaid Services is soliciting ideas from stakeholders about new approaches that might be employed in the development of state relief and empowerment waivers, also known as section 1332 waivers.

Last year CMS loosened section 1332 waiver requirements and offered states four concepts for how to take advantage of both the waivers and the less stringent requirements.  Section 1332 waivers permit states to seek exemption from selected requirements of the Affordable Care Act to pursue new approaches to enhancing access to quality, affordable health insurance.  Through a new request for information, CMS now seeks

…to build a library of options, through more waiver concepts, so that states have additional illustrative ways to take advantage of this new flexibility.

In its RFI, the agency suggests the following possibilities:

  • Waiver concepts that states could potentially use alone or in combination with other waiver concepts, state proposals, or policy changes; 
  • Waiver concepts that could advance some or all of the principles outlined in the 1332 Guidance released in 2018; 
  • Waiver concepts that incorporate the entire range of waivable requirements allowed under section 1332; and
  • How states might combine the flexibilities available under 1332 with other flexibilities that exist under federal law, including regulatory flexibility, Section 1115 Medicaid waivers, as well as state law. 

Through such approaches, CMS aspires to give states the tools they need to address what the agency describes as “struggling” individual health insurance markets.

Learn more about what CMS is doing, why it is doing it, and what it seeks from stakeholders through an explanation in the CMS blog article “Taking action and providing states options to minimize economic burden created by the ACA” and through the RFI “Request for Information Regarding State Relief and Empowerment Waivers.”  Comments are due July 2.