1332 State Innovation Waivers

Under Section 1332 of the ACA, states can apply for State Innovation Waivers (also referred to as section 1332 waivers) and pursue innovative strategies to adapt many of the law's requirements to suit the state's specific needs. To receive approval, the state must demonstrate that a proposed section 1332 waiver meets the statutory guardrails to provide coverage that is at least as comprehensive as the coverage provided without the waiver; provides coverage and cost-sharing protections against excessive out-of-pocket spending that are at least as affordable as without the waiver; provides coverage to at least a comparable number of residents as without the waiver; and does not increase the federal deficit. Before submitting its section 1332 waiver application the state must also provide a public notice and comment period, including public hearings, sufficient to ensure a meaningful level of public input, and enact a law providing for implementation of the waiver. Under a section 1332 waiver, a state may receive pass-through funding associated with the resulting reductions in federal spending on Exchange financial assistance consistent with the statute.