CHA News Article

CMS Releases New State Innovation Waiver Concepts

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released four new waiver concepts that illustrate how states might take advantage of new flexibilities provided in recently released guidance related to Section 1332 state innovation waivers established under the Patient Protection and Affordable Care Act. 

The four waiver concepts — account-based subsidies, state-specific premium assistance, adjusted plan options and risk stabilization strategies — are described in CMS’ discussion paper and fact sheet

States are not required to use these concepts in their waiver applications, but those that do may use them alone or in combination with other concepts, state proposals or policy changes. To gain CMS approval, states’ waiver applications must meet Section 1332 statutory requirements, including the four guardrails — comprehensiveness, affordability, coverage and federal deficit neutrality — established by previous CMS guidance. However, CMS notes it cannot determine whether a waiver proposal meets the guardrails until it receives a specific proposal. In its discussion paper, CMS notes many significant operational questions states should address in pursuing a more complex waiver, and continues to encourage states to propose other innovative approaches to meet their populations’ unique needs.

Pursuant to Assembly Bill 1810 (Chapter 34, Statutes of 2018) Covered California is currently exploring options — in consultation with stakeholders including CHA  — for providing financial assistance to help low- and middle-income Californians access health care coverage. Covered California will report options to the Legislature, Governor and Council on Health Care Delivery Systems by Feb. 1, 2019. The report will include options that do not require a federal waiver authorized under Section 1332, as well as options to assist low-income individuals who are spending a significant percentage of their income on premiums, even with federal financial assistance, and individuals with an annual income of up to 600 percent of the federal poverty level. Covered California is also required to consider maximizing all available federal funding and, in consultation with the California Department of Health Care Services, determine whether federal financial participation for the Medi-Cal program would otherwise be jeopardized.