Section 1332 State Innovation Waivers: Current Status and Potential Changes

Appendix 1: Descriptions of ACA Provisions That May Be Waived under Section 1332 Authority
ACA Provision Description
Individual Mandate Requirement for individuals to have minimum essential health insurance coverage or pay a tax penalty.
Large employer mandate Requirement for firms with more than 50 employees to provide affordable health benefits to full time workers and their dependents or pay a tax penalty.
Qualified health plan (QHP) standards Includes requirements that health plans offered through the exchange must cover 10 essential health benefits, limit annual cost sharing for covered benefits, and be offered with a variety of cost sharing levels that correspond to metal tiers (bronze, silver, gold, platinum).  These standards include other cost sharing rules (including requirement for non-network emergency services to be covered at in-network coinsurance levels), and the option for states to prohibit abortion coverage under QHPs offered through the Exchange.
Standards for health insurance exchanges Includes requirements for the establishment of state exchanges that operate web sites displaying plan choices, provide navigator and call center assistance, offer annual open enrollment periods, determine eligibility for financial assistance, and certify that QHPs meet requirements for network adequacy, fair marketing practices, and other standards.
QHP cost sharing subsidies Requirement that insurers offering exchange plans offer enhanced silver plans, with lower deductibles and other cost sharing, for eligible enrollees with income up to 250% of the poverty level.
QHP premium subsidies Requirement to provide sliding scale premium tax credits for eligible QHP enrollees with income between 100% and 400% of the poverty level.  The tax credit amount is based on the cost of the second lowest cost silver plan in the Exchange.  Subsidies are only payable for QHP coverage enrolled through an Exchange. The ACA premium tax credit provisions also require that eligible individuals must be citizens or lawfully present residents of the US and cannot be eligible for other minimum essential coverage.
Subsidy pass through Allows states to request to have premium tax credit and cost-sharing subsidies, that residents would otherwise have received, instead provided in an aggregate amount to be used to implement the state waiver.
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