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The Department of Health and Human Services has issued guidance to states seeking a 1332 waiver to about every major component of the Affordable Care Act as the deadline for the new program approaches.
Starting in January 2017, states may expand on innovative models to coverage, payment and delivery models of the ACA through an approved 1332 waiver.
Under the waiver, states are given flexibility while receiving federal funding to implement alternative models of healthcare coverage.
States may modify the rules on benefits and subsidies available through the marketplaces; reallocate premium tax credits and cost-sharing reductions; or replace their marketplaces and come up with alternative ways to provide health plan choices.
States may modify or eliminate the required individual mandate or the requirement that large employers offer affordable coverage to full-time employees.
The State Innovation Waivers may be combined with Medicaid waivers such as in Arkansas, which uses Medicaid funds to purchase qualified health plans on the marketplace, according to The Commonwealth Fund.
The waivers allows states to take the lead in regulating their insurance markets.
The waivers come with stipulations that states continue to provide coverage that is at least as comprehensive without the waiver; provide cost-sharing protections against excessive out-of-pocket costs; and provide coverage to a comparable number of residents.
The waiver must also not increase the federal deficit.
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HHS and the Centers for Medicare and Medicaid Services will also assess whether a proposal takes into account the effects on vulnerable residents, including low-income individuals, elderly individuals, and those with serious health issues or who have a greater risk of developing serious health issues.
The effect on all state residents is considered. A waiver must not decrease the number of individuals with coverage.
The waivers take effect as early as January 1, 2017. Guidance on the waivers is available starting Dec. 16.
Here is the full final rule: