• Issue Brief
  • July 12, 2019

Section 1332 State Innovation Waivers

Section 1332 of the Affordable Care Act (ACA) allows states to seek a waiver of key coverage provisions in the law and to experiment with different health coverage models. States can seek a Section 1332 waiver in conjunction with a Section 1115 Medicaid waiver, but cannot use a Section 1332 waiver to change Medicaid program requirements. States may not waive the private insurance protections enacted under the ACA.

States with an approved waiver receive the federal funds that would have been provided to their residents through premium tax subsidies and cost-sharing reductions as “pass through” funds to support the state innovations.

On Dec. 21, 2018 CHA joined with allied children’s organizations on a letter to CMS urging the administration to rescind Oct. 22 guidance, which give states new flexibility under the waivers. The guidance would loosen current guardrails related to the coverage, scope and affordability requirements under Section 1332. 

On July 2, 2019, CHA again joined with allied children’s organizations to submit comments in response to a request for information that sought input on ways to encourage states to use the new flexibilities included in the 2018 guidance. The allied children’s groups urged the administration to rescind the 2018 guidance and protect children’s access to timely, appropriate and affordable health care.