1332 State Innovation Waivers
Under Section 1332 of the PPACA, states can apply for State Innovation Waivers and pursue innovative strategies to adapt many of the law's requirements to suit the state's specific needs. To receive approval, the state must demonstrate that a proposed waiver will provide access to quality health care that is at least as comprehensive and affordable as would be provided without the waiver, will provide coverage to at least a comparable number of residents ofthe state as would be provided coverage without a waiver, and will not increase the federal deficit. Before submitting its Section 1332 waiver application the state must also provide a public notice and comment period, including public hearings, sufficient to ensure a meaningful level of public input, and enact a law providing for implementation of the waiver. Under a Section 1332 waiver, a state may receive pass-through funding associated with the resulting reductions in federal spending on Marketplace financial assistance consistent with the statute.
General information about this opportunity
Last Known Status
Centers For Medicare and Medicaid Services, Department of Health and Human Services
Type(s) of Assistance Offered
B - Project Grants
Fiscal Year 2016
N/AFiscal Year 2017
It is expected that 4 requests and 2 awards will be made in FY17.Fiscal Year 2018
CCIIO awarded four states (AK, HI, MN and OR) grant funds in 2018. CCIIO received five applications (ME, MD, NJ, OH, WI) in 2018 and approved four waivers (MD, MD, NJ, WI) for 2019.Fiscal Year 2019
CCIIO awarded eight states (AK, HI, ME, MD, MN, NJ, OR, WI) grant funds in 2019. CCIIO is expected to receive five applications (CO, DE, ND, RI, and MT).
The Affordable Care Act, Section 1332
Who is eligible to apply/benefit from this assistance?
This funding opportunity is only open to US States, Territories and Possessions.
Written notification from HHS/CMS that a complete 1332 Waiver Application package has been submitted for review.
What is the process for applying and being award this assistance?
Preapplication coordination is required. N/A
2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. N/A
OMB Circular N. A-102 applies. Applicants must complete a section 1332 waiver application package available at http://XXXXXXXXXXXX. This package must be submitted via Grants.gov. HHS/CMS will review the request and coordinate accordingly with the applicant. A review team will review the package and make recommendations. The final approval authority rest with the Secretary of Health and Human Services and the Secretary of the Treasury (collectively, the Secretaries). Technical assistance may be provided to any state interested in a waiver. States can electronically submit their applications, as well as any supporting documentation or information, to the 1332 e-mail mailbox. The Departments will render decisions on both completeness and approval; if complete, the application is posted for a Federal comment period.
Approval/Disapproval Decision Time
No more than 180 days from the determination of application completeness of a section 1332 waiver application
The approval letter and specific terms and conditions include information regarding waiver extension requests.
How are proposals selected?
How may assistance be used?
Federal pass-through funding made available through a Section 1332 waiver must be used only to implement the waiver program. The amount of federal pass-through funding equals the Departments’ annual estimate of the federal financial assistance, including premium tax credits (PTC), small business tax credits, or cost-sharing reductions, provided pursuant to the PPACA that would have been paid on behalf of participants in the Exchange in the state in the calendar year in the absence of the waiver, but will not be paid as a result of the waiver. Federal pass-through funding made available through Section 1332 must be used only to implement the waiver program. The pass-through funds cannot be obligated by the state prior to the waiver effective date. The state agrees to use the full amount of pass-through funding for purposes of implementing the state’s plan as approved by the Departments. To the extent any pass-through funding exceeds the amount necessary to implement the waiver program, the remaining funds must be rolled over and used for purposes of implementing the state’s plan under the waiver. If the waiver is not extended or is suspended/terminated, unused pass-through funds will be returned to the Treasury promptly, and the state will comply with all the necessary steps to do so.
What are the requirements after being awarded this opportunity?
Yes – states must conduct periodic reviews and report on progress, including relevant data metrics, as laid out in the specific terms and conditions of the state’s waiver. Additionally, pursuant to 31 CFR 33.120(f) and 45 CFR 155.1320(f), at the request of the Departments of Health and Human Services and Treasury (the Departments), states must fully cooperate with the Departments or an independent evaluator selected by the Departments to undertake an independent evaluation of any component of the waiver. Finally, the state must participate in all monitoring calls with the Departments that the Departments deem necessary.
The draft and final annual reports are to be published on a State's public Web site within 30 days of submission to and approval by the Secretary of Health and Human Services, respectively.
Other Assistance Considerations
Formula and Matching Requirements
Statutory formula is not applicable to this assistance listing.
Matching requirements are not applicable to this assistance listing.
This program has MOE requirements, see funding agency for further details. Additional Information: Maintenance of Effort requirements, as applicable, will be detailed in a grantee's Special Terms and Conditions document. States will only receive federal passthrough funding assistance to which it has been calculated they are entitled in accordance with statutory and regulatory requirements, and are expected to supplement any remaining costs of the waiver program with state and/or other funding sources.
Length and Time Phasing of Assistance
The pass-through funds cannot be obligated by the state prior to the waiver effective date. The state agrees to use the full amount of pass-through funding for purposes of implementing the state’s plan as approved by the U.S. Department of Health and Human Services (HHS) and the Department of the Treasury (collectively, the Departments). To the extent any pass-through funding exceeds the amount necessary to implement the waiver program, the remaining funds must be rolled over and used for purposes of implementing the state’s plan under the waiver. The default waiver period is five years, but waivers can be extended beyond that timeframe. If the waiver is not extended or if it is suspended/terminated, unused pass-through funds will be returned to the Treasury promptly, and the state will comply with all the necessary steps to do so. Assistance is in the form of a grant, and will be released using the Payment Management System. Method of awarding/releasing assistance: as requested. Method of awarding/releasing assistance: Quarterly.
Who do I contact about this opportunity?
Regional or Local Office
7501 Wisconsin Ave.
Bethesda, MD 20814 US
200 Independence Ave, SW
Washington, DC 20204 US
(Cooperative Agreements) FY 18$244,619,917.00; FY 19 est $939,201,611.00; FY 20 Estimate Not Available FY 17$428,864.00; FY 16$0.00; -
Range and Average of Financial Assistance
Regulations, Guidelines and Literature
Regulations governing the application process for State Innovation Waivers can be found at the Federal Register at 77 Fed. Reg. 11700 (Feb. 27, 2012). Among other things, these regulations provide guidance on how to apply for a waiver and what an application from a state must contain, including actuarial and economic analyses. The regulations detail public notice and comment requirements that a state must comply with before an application is submitted, including holding public hearings, in order to facilitate a meaningful level of public involvement, input, and transparency in the state application process. They also describe the Federal public notice and comment process that will occur after a completed application has been received. The regulations also describe the requirements for post-award reporting and the standards under which post-award monitoring will take place. In December of 2015, the Departments of Health and Human Services and Treasury (Departments) released Federal Register guidance at 80 Fed. Reg. 11700 (December 16, 2015) that provided additional information on PPACA Section 1332's statutory requirements. On May 11, 2017, Departments posted a 1332 waiver application checklist to help states as they develop and complete the required elements of their applications. This checklist follows a March 2017 letter from U.S. Health and Human Services' Secretary Price to all states encouraging the use of innovative strategies to strengthen their health insurance markets.
Examples of Funded Projects
Fiscal Year 2016
N/AFiscal Year 2017
Alaska 1332 Waiver Program request to establish a state-re-insurance program Hawaii 1332 Waiver Program request to waive key SHOP requirements to implement the Hawaii Prepaid Healthcare ActFiscal Year 2018
Hawaii Small Business Health Options Program (SHOP) Waiver Program, Alaska Reinsurance Waiver Program, Minnesota Reinsurance Waiver Program, Oregon Reinsurance Waiver Program.Fiscal Year 2019
Hawaii Small Business Health Options Program (SHOP) Waiver Program, Alaska Reinsurance Waiver Program, Minnesota Reinsurance Waiver Program, Oregon Reinsurance Waiver Program. Maine Reinsurance Waiver Program, Maryland Reinsurance Waiver Program, New Jersey Reinsurance Waiver Program, Wisconsin Reinsurance Waiver Program.