New DI Discussion on the Next Big Thing in ACA Implementation: State Innovation Waivers

July 2015

New DI Discussion on the Next Big Thing in ACA Implementation: State Innovation Waivers

Section 1332 of the ACA includes provisions on Innovation Waivers, which allow states to waive some of the requirements of ACA and propose alternatives in several key areas. Shortly after Center for Consumer Information and Insurance Oversight (CCIIO) posted a new webpage specifically on the topic of 1332 waivers, NADP posted the following with background information and education. Members are encouraged to post updates from their states and ideas on how the waivers could impact dental.

New CCIIO Webpage re State Innovation Waivers
The Center for Consumer Information & Insurance Oversight (CCIIO) has published a new webpage dedicated to resources, regulations and guidance for states on ACA Section 1332 State Innovation Waivers. The webpage provides new Frequently Asked Questions (FAQs) and directions on the submission process for states considering a waiver.

With subsidies upheld in King v. Burwell, these waivers are likely the next big thing to watch in Affordable Care Act (ACA) implementation. The Exchange Policy Workgroup (EPW) has discussed early state activity in considering waivers and some of that tracking is included in the background below.

Please use this Dental Interact (DI) thread to post news items and updates as you see them. Are there other states you’ve heard of that are considering applying for a waiver? For what purpose? How are the discussions going? How will children’s dental coverage be impacted? 

Background
Section 1332 of the ACA includes provisions on Innovation Waivers, which allow states to waive some of the requirements of ACA and propose alternatives in several key areas:

• The individual mandate/penalty
• The employer mandate/penalty
• Standards for a basic health insurance policy
• Establishment of an Exchange
• How federal subsidies reduce premiums and copays

If granted, states with innovation waivers can collect all the federal dollars that would be used for premium subsidies, cost-sharing reductions (CSRs) and small business tax credits to finance health coverage according to the new state law.

As noted by Health Affairs, the waivers “don’t exempt states from accomplishing the aims of the ACA, but give them the ability (and responsibility) to fulfill the aims in a different manner while staying between certain guardrails.” In order to receive the waiver, state law must ensure that:

• Individuals receive insurance coverage that is at least as comprehensive as ACA coverage;
• The coverage is as affordable as it would be under ACA;
• As many people would be covered as with the ACA; and
• The state program does not increase the federal deficit.

State Innovation Waivers cannot take effect before Jan. 1, 2017; however, applications can be submitted prior to that date.

Before submission, states are required to provide public notice, comment period and public hearings to ensure a meaningful level of public input. After submission, Health and Human Services (HHS) and Treasury will conduct a preliminary review to determine whether the application is complete within 45 days after submission. The application will then be made public for a federal comment period, and a final decision will be issued no later than 180 days after the preliminary determination of a complete application.

While it may be the case that states have the authority under state law to develop and submit waivers, some will need or want to establish this authority in legislation and/or organize a task force to develop a waiver plan.

The following is a list of some state bills we’ve seen this legislative session that touch on 1332 waivers.

For more information, review the CCIIO website and related resources online here. Also, NADP hosted a webinar with Cindy Gillespie, Principal in Dentons’ Public Policy and Regulation practice, on 1332 State Innovation Waivers—a recording is available for purchase online here.