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Waiver Checklist: CMS Details How States Could Sidestep ACA Provisions

Analysis  |  By Steven Porter  
   July 16, 2019

The tools offer greater detail on how states might make the most of four waiver concepts the administration released last fall.

After urging states to explore new potential ways to bypass provisions of the Affordable Care Act, the Centers for Medicare & Medicaid Services released more details Monday on how states might do so.

The details include a template for each of the four waiver concepts CMS released last fall and a checklist for states putting together waiver applications under the ACA's Section 1332. The tools highlight specific areas in which the Trump administration has given states greater flexibility than the Obama administration had.

States aren't required to use these tools, and following the checklist and templates doesn't guarantee that an application will be approved, since states must meet a variety of statutory and regulatory requirements, CMS said.

"While states have tremendous opportunities to strengthen their health insurance markets through a State Relief and Empowerment Waiver, we've also heard from states that they need more help and detail from CMS in putting together their waiver applications," CMS Administrator Seema Verma said in a statement. "This new package of resources should reduce some of the guesswork and burden on states as they craft their waiver applications."

The four waiver concepts are based on a revised guidance document CMS released in October to give states greater flexibility. Some have questioned the legality of that revised guidance since it avoided formal notice-and-comment rulemaking.

Related: New ACA Waivers Could Subsidize Short-Term Coverage

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

Related: Is Trump Pushing Health Insurance Innovation or an ACA Rollback?

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


Officials have provided a 12-page checklist for states to consider when devising their waiver applications.

The administration also released a 10-11-page template for each of the four waiver concepts it had outlined last fall.

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