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CMS Asks States to Brainstorm New ACA Waiver Concepts

By Steven Porter  
   May 01, 2019

The four waiver concepts CMS released last fall 'were just the beginning' as the agency seeks to build 'a library of options,' says Administrator Seema Verma.

In a request for information released Wednesday, the Centers for Medicare & Medicaid Services asked states to generate ideas for new ways they could bypass certain provisions of the Affordable Care Act, through so-called "State Relief and Empowerment Waivers."

The nationwide brainstorming session aims to add waiver concepts to the list of four that CMS released last fall after it issued revised guidance governing ACA Section 1332 waivers. Trump administration officials say the move will enable creative problem-solving at the local level, while critics worry the wider waivers could destabilize ACA-compliant markets.

"Ultimately, the goal here is to see states develop new waiver concepts and submit waiver applications that improve their health insurance markets," CMS Administrator Seema Verma wrote in a blog post. "To help states with that process, CMS intends to build a library of options, through more waiver concepts, so that states have additional illustrative ways to take advantage of this new flexibility."

"Indeed, the four waiver concepts we released last fall were just the beginning," Verma added.

The RFI, which CMS released with the U.S. Department of the Treasury, specifically asks for states to include ideas that "incorporate the entire range of waivable requirements allowed under Section 1332," while remaining within the law's guardrails. (Remember: The way the Trump administration has interpreted those statutory guardrails differs from the way the Obama administration interpreted them.)

Only certain parts of the ACA may be waived. The provisions protecting people with preexisting conditions are not among them, as Verma emphasized last week.

Comments will be accepted through July 2.

Related: New ACA Waivers Could Subsidize Short-Term Coverage

Related: Verma Lambastes ACA, Giving States 4 Ways to Bypass It

Related: Verma Seeks to Clarify Commitment to Preexisting Condition Protections

Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.


The federal agency is asking for more ways states can sidestep waivable ACA provisions.

The goal is to enable local policymakers to solve local problems.

Critics worry more and bigger waivers could punch a hole in the ACA-compliant market.

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