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Consumer Advocates Should Review New Guidance for 1332 Waivers

By Cheryl Fish-Parcham,


Last month, HHS and the Department of the Treasury issued new guidance on state innovation waivers that includes stronger protections for low-income and vulnerable consumers. We believe many of its provisions should be added to federal rules.

1332 waivers allow states to experiment with ways to provide quality, affordable health coverage

State innovation waivers, established under Section 1332 of the Affordable Care Act, allow states to apply for waivers of several provisions related to private insurance in order to establish innovative ways of providing affordable coverage and care. States can divert federal money that would have been spent on premium credits and cost-sharing reductions for lower- to middle-income state residents and spend it on the state’s innovation program.

In the past, we’ve described our concerns regarding whether the waivers would adequately protect vulnerable populations.

Families USA welcomes the new protections for vulnerable residents in the 1332 guidance

We are pleased with many of the new federal requirements. The requirements stipulate that when states request a waiver, they must show that their innovation:

  • will not reduce coverage to vulnerable groups, including low-income individuals, elderly individuals, those with serious health issues, and those at greater risk of developing serious health issues
  • will not make coverage less affordable for these vulnerable groups or increase their out-of-pocket cost burdens
  • is as comprehensive for state residents, taking into account the comprehensiveness of coverage provided to vulnerable groups

See our more in-depth summary of the guidance.

Consumer advocates should comment on the federal guidance

The new federal guidance is helpful to vulnerable populations and should be made permanent as part of federal rules. The public can also comment on the guidance at any time, and consumer advocates should do so.

In the next few months, advocates may want to comment to HHS and Treasury about what they like in the new guidance, any improvements they seek, and aspects that should be added to final federal rules. Read the guidance to see where to send your comments.

Next steps on 1332 waivers at the state level

Some states (including California, Hawaii, Massachusetts, Minnesota, and New Mexico) have started thinking seriously about innovation waivers. Consumer advocates have an important role to play in these discussions—they can react to state officials’ proposals and set forth ideas about coverage improvements and whether state innovation waivers are a possible vehicle for achieving them.

The new guidance requires that states give the public at least 30 days to comment on proposed waivers. The public can also comment to HHS and Treasury once a waiver is submitted. But advocates can start much earlier to make sure that consumers have a strong voice at the table.