• Issue Brief
  • February 14, 2019

Section 1332 State Innovation Waiver Guidance

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 its Oct. 22 guidance, which gives states new flexibility under the waivers. The guidance loosens current guardrails related to the coverage, scope and affordability requirements under Section 1332.