The current state of CMS' section 1332 innovation waivers: 7 things to know

As Congressional Republicans push forward with ACA repeal and replacement efforts, a spotlight has fallen on the health law's section 1332 innovation waivers, according to a recent Kaiser Family Foundation brief.

The waivers allow states to opt out of specific requirements of the ACA to implement different health coverage models, as long the models have similarly comprehensive benefits and are as affordable, comparable in terms of number of state residents covered and do not increase the federal deficit. The Senate GOP's healthcare bill only preserves the requirement alternative models do not increase the federal deficit.

Here are seven things to know about the current status of section 1332 waivers.

1. States have used section 1332 waivers limitedly. So far, six states — Alaska, California, Hawaii, Iowa, Minnesota and Vermont — have filed waiver applications. 

2. Hawaii is the only state with an approved waiver. Vermont's waiver is under review. Both states submitted section 1332 waivers with relatively narrow requests, including continuing existing coverage requirements and enrollment procedures for small group health plans, KFF reports.

3. California withdrew its section 1332 waiver application after the November 2016 election. The state sought to allow undocumented immigrants to purchase health insurance through California's ACA exchange without premium subsidies.

4. The federal government is currently reviewing Alaska's waiver application, which requests federal pass-through funding to finance its reinsurance program, KFF states.

5. Minnesota filed a section 1332 waiver application at the end of May seeking similar market stabilization assistance as Alaska, in addition to broader requests to change its individual market.

6. Iowa submitted a request similar to Alaska's reinsurance program, but like Minnesota is looking for broader changes to its individual market. The state proposed eliminating its ACA exchange and providing federal assistance to eligible individuals buying health coverage off the exchange. Iowa and Minnesota asked the Trump administration to expedite the waivers. 

7. HHS Secretary Tom Price, MD, sent a letter in March to all state governors encouraging them to apply for 1332 waivers. Only seven states said they would consider pursuing a waiver. 

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