State Relief and Empowerment Waiver Application Resources
State Relief and Empowerment Waiver application resources from the Centers of Medicare and Medicaid Services (CMS) offer a chance to support a stable health insurance market. A stable market is an abundance of quality and affordable health care plans.
New resources support the improvement of health insurance markets for many states. The State Relief and Empowerment Waivers make coverage more affordable for beneficiaries. Resources include a checklist of waiver elements.
States could better understand and navigate the section 1332 waiver application process by using templates from new resources. Model concepts are meant to improve the health insurance market and offer opportunities for higher quality health care options.
State Relief and Empowerment Waiver Application Resources
The Department of Health and Human Services (HHS) is looking for comments on new programs and waiver ideas. For HHS to grant a request for a section 1332 waiver, HHS must establish the waiver’s access to coverage.
Waivers must allow access to coverage that’s at least equivalent to and affordable as what the Affordable Care Act (ACA) offers without it. Also, coverage must match the same number of state residents as it would without. Additionally, the waiver may not increase the federal deficit.
These qualifications are “guardrails.” The HHS looks to the public for ideas they can use to develop innovative waiver programs. However, to use them, ideas must meet section 1332 guardrails.
Applications for 1332 waivers showing the following 5 principles by the HHS. Submit all comments by July 2, 2019, for consideration.
Elements include providing increased access to affordable private market coverage, encourage sustainable spending growth and foster state innovation. Also, the waiver must support and empower those in need by promoting consumer-driven health care.
CMS Offers State Relief and Empowerment Waiver Guidance
States may have new resources to use as they stabilize their insurance markets through different methods like reinsurance.
In a recent press release, CMS Administrator Seema Verma said:
“While states have tremendous opportunities to strengthen their health insurance markets through a State Relief and Empowerment Waiver, we’ve also heard from states that they need more help and detail from CMS in putting together their waiver applications. This new package of resources should reduce some of the guesswork and burden on states as they craft their waiver applications…”
Later in the press release, she mentions the messy history of state insurance markets. States with healthcare.gov saw premium rates double between the years of 2013 and 2017. Over 50% of the country’s insurance markets reduced to one issuer by 2018.
The 1332 waiver helps the leaders of each state respond to challenges in the health insurance market. Waivers are important because they provide states more flexibility when waiving certain ACA requirements. This is due to Section 1332 stabilizing their markets for health insurance.
Some states complain about the application for the waiver and how to issue a compliant initiative. Although, new resources may help states with applying for the waivers.
New Waiver Resources
Assisting states in the application process comes to new resources. Including, a summary of each waiver concept’s strengths and templates. Summaries must specify the application requirements.
CMS also includes a checklist. This tool has been useful to states in the past.
The checklist identifies each aspect of the waiver application. Specifically, from waiver concepts to regulatory provisions citations.
Every state relief and empowerment waiver concept paper include a list of steps to assist them in understanding the application process. Also, the paper includes an executive summary, background and the concept’s specific description.
Section 1332 Templates
A State Relief and Empowerment Waiver is otherwise known as a section 1332 waiver. This allows states to investigate modern approaches for giving their residents better access to quality, more cost-effective health insurance benefits.
Section 1332 of the Patient Protection and Affordable Care Act (PPACA) has different templates or models summarizing what each state must include in their applications. Each model is roughly 30 pages long, all including 10 sections and 7 appendices.
Templates include subject matter about legislative support and reporting targets. Also, the plan for implementation and its timeframe is part of each template. Content may also include details regarding public telecast (communications), governmental planning and more.
Expediting the application process may decrease the burden for administrators. This could encourage states to file a waiver application, according to the Centers of Medicare and Medicaid Services.
The 2018 Proposal Concepts for Waivers:
- State specified premium assistance waivers: An idea for states looking to bring-in a specific demographic of people to their Medicaid program. This waiver allows a state-administered subsidy structure; this may be customizable to the state’s needs and population.
- Account-based subsidies waivers: This concept suggests that states may directly deposit money into accounts for recipients. Also, they may select their own private health insurance policy. Under this waiver, beneficiaries may use both their individual and employer funds alongside state funding to purchase a plan.
- Adjusted plan options: Also known as APO waivers. The design was for states seeking to increase the affordability and plan options. This plan option concept allows states to engage financially for various health insurance policies. APO’s also allow states to extend eligibility, past ACA restrictions.
- Risk stabilization strategies waivers: States may use this waiver to address healthcare costs at high-risk. States may use reinsurance programs or high-risk pools that lie beyond the limits of the ACA.
Finding State Relief and Empowerment Waiver Application Resources
CMS mentions that states may use a combination of these concepts. States can use these waivers for reinsurance programs that help to lower premiums on the marketplace. However, since the reform of the original ACA intent of these waivers, 8 have seen approval, 4 are pending, 3 are incomplete and 3 have been withdrawn.
The Commonwealth Fund reports that reinsurance modifications where waivers have been successful. An 8-20% decline in premiums was found in states using the 1332 waiver insurance initiatives in 2018.
The Government Accountability Office (GAO) emits an opinion about CMS issuing the new 2019 guidelines. The GAO’s assessment explains that the 2018 guidelines don’t qualify for an exemption because they fall under the Congressional Review Act.
States must file applications to the House of Congress and the comptroller general in order to get approval. In turn, rules may not take effect until after all 3 parties receive and approve the state’s waiver application.
Finally, when the Departments review each state’s section 1332 waiver application, regulations and statutory requirements are applied. The Departments focus on providing states with the freedom to be original and innovative while responding to necessities.