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This week the U.S. Departments of Treasury and Health and Human Services announced that they were changing the requirements for granting 1332 waivers to states. The Affordable Care Act created 1332 waivers to allow states to develop alternative approaches to some of the law’s requirements, including the essential health benefits (EHBs) and the premium tax credits. Several states have been granted 1332 waivers to set up reinsurance programs that helped hold down premiums, but so far no states have used them to fundamentally reshape their individual markets. The Affordable Care Act put up “guardrails”: coverage under a 1332 waiver had to be at least as comprehensive, at least as affordable, cover a comparable number of residents, and not increase the federal deficit. Some states have argued that the guardrails, and the guidance issued in 2015 on how to apply them, made it impossible to make big changes. The new requirements replace the 2015 guidance and reinterpret the guardrails.

We’re reviewing the new guidance and working on an OT-focused write-up. For information on the 1332 changes, check out the following links:

For a general summary, the blog of the journal Health Affairs: https://www.healthaffairs.org/do/10.1377/hblog20181023.512033/full/.

Another summary from the National Academy of State Health Policy (NASHP): https://nashp.org/administration-proposes-significant-policy-changes-for-state-insurance-markets-through-new-1332-waiver-regulations/.     

For the CMS press release and fact sheet: https://www.cms.gov/newsroom/press-releases/trump-administration-announces-state-relief-and-empowerment-waivers-give-states-flexibility-lower.

For the full guidance document: https://www.federalregister.gov/documents/2018/10/24/2018-23182/state-relief-and-empowerment-waivers.