HHS Publishes Guidance Detailing Criteria for 2017 ACA Waivers
Under section 1332 of the ACA, states can ask the HHS secretary to waive certain ACA provisions, including those related to:
- Federal health subsidies;
- Health insurance marketplaces;
- The individual mandate; and
- Shared responsibility requirements for employers with 50 or more full-time workers.
At the same time, states applying for such a waiver must:
- Ensure a comparable insured rate as would be expected under the law;
- Ensure that health coverage provides benefits that are equal to or greater than the "essential health benefits" under the ACA;
- Provide cost-sharing protections to make coverage just as affordable as it would be under the ACA; and
- Prove their plan will not increase the federal deficit.
The waivers cannot be used to exempt states from the ACA's risk adjustment program or limitations on how much insurers can charge based on beneficiaries' ages. In addition, states will not be able to use the waivers to extend eligibility for Medicaid or Children's Health Insurance Programs. However, they can request a separate waiver under section 1115 of the Social Security Act to make changes to those programs in conjunction with a section 1332 waiver (Rosenfeld, "Road to Reform," California Healthline,4 /1).
If a waiver is approved, states would receive funding equal to the amount of federal financial assistance they would have received had they continued to implement the ACA.
The guidance clarified that redesigned plans sought through the waivers:
- Cannot decrease the number of people enrolled in Medicaid or CHIP;
- Cannot decrease the number of people receiving plans that cover ACA's 10 essential health benefits; and
- Must ensure that health plans available under the redesigned system be about as affordable for residents as plans offered through the ACA's exchanges.
Further, HHS noted it would deny any proposals that would result in coverage losses, particularly among:
- Low-income and elderly individuals;
- Individuals with serious health issues; or
- Individuals susceptible to developing serious health issues.
In addition, the guidance appears to prohibit waivers that would eliminate the ACA's individual or employer mandates in the states. The guidance noted that "certain changes that affect [IRS] administrative processes may make a waiver proposal not feasible to implement." It continued, "At this time, the IRS is not generally able to administer different sets of rules in different states" (Modern Healthcare, 12/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.