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Agencies Provide More Guidance on State Innovation Waivers

Waivers for State Innovation, 31 CFR Part 33, 45 CFR Part 155, 80 Fed. Reg. 78131 (Dec. 16, 2015); Fact Sheet: HHS and Treasury Issue Additional Guidance on 1332 Waivers


Fact Sheet

Visit the Health Care Reform Community on Checkpoint to join the discussion on this development (for Checkpoint subscribers to EBIA’s Health Care Reform manual).

HHS and the IRS have jointly issued additional guidance about state innovation waivers. As background, health care reform authorizes states to apply for waivers from certain of its provisions, including requirements regarding qualified health plans (QHPs), Exchanges, premium tax credits, employer shared responsibility, and the individual mandate. However, a state must provide coverage that is at least as comprehensive and affordable as would be provided absent the waiver, and the number of state residents with coverage must be comparable to the number of residents who would have coverage absent the waiver. Also, an innovation cannot increase the federal deficit (see our article).

The guidance provides additional information about how state waiver applications will be evaluated, including how the agencies will determine whether a state has met the comprehensiveness, affordability, coverage, and deficit neutrality requirements. The guidance also describes the funding that is available for states to implement a waiver. States are also advised that, until further guidance is issued, the federal Exchange platform cannot accommodate, and the IRS cannot administer, different sets of rules for different states, so certain proposals may make it infeasible to implement a waiver at this time.

EBIA Comment: Although state innovation waivers are not available until January 1, 2017, this guidance serves as another reminder that some states may already be preparing waiver applications. It will be interesting to see how many waiver applications are filed and whether the agencies decide to approve them for 2017. Employers and their advisors will be particularly interested in whether any applications include a request for waiver of the employer shared responsibility provisions. For more information, see EBIA’s Health Care Reform manual at Section XXI.G (“Innovation Waivers Allow State Health Reform Alternatives”).

Contributing Editors: EBIA Staff.

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