Capitol Correspondence - 05.04.19

CMS Requests Ideas for States Seeking to Develop Section 1332 Waivers (“State Innovation Waivers”)

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ANCOR is sharing this blog post by the Centers for Medicare and Medicaid Services (CMS) because developments ensuing from this Request for Information (RFI) could set precedent for Medicaid-funded disability supports. This this article by Modern Healthcare also provides an additional readout on the RFI (readers might need to scroll down past the advertisement to see the article text).

As shared by CMS:

Under the President’s clear leadership, in 2018, the Centers for Medicare & Medicaid Services (CMS) and the Department of the Treasury (collectively, the Departments) issued new guidance announcing policy changes that increase states’ flexibility to waive certain ACA requirements. The Departments also released four waiver concepts that illustrate how states might take advantage of this flexibility. By releasing these concepts, the Departments hope to spur further conversations with states and encourage innovative thinking on how states can take action to strengthen their markets.

Today, the Departments are taking another step to prime discussions and are issuing a request for information (RFI) asking for more ideas on innovative programs and waiver concepts that states could consider in developing a State Relief and Empowerment Waiver plan (also referred to as “Section 1332 waiver” or “State Innovation Waiver”).


The new guidance the Departments issued last fall gives states the flexibility they need to address problems in their market. The prior guidance issued by the previous administration proved to be unnecessarily restrictive for states, which may be why very few states have come forward with new ideas to improve their markets through Section 1332 waivers. 


In this RFI, the Departments are specifically asking for ideas for additional waiver concepts that states may be able to use to develop innovative waiver programs that meet the section 1332 guardrails, including the following possibilities: 

  • Waiver concepts that states could potentially use alone or in combination with other waiver concepts, state proposals, or policy changes; 
  • Waiver concepts that could advance some or all of the principles outlined in the 1332 Guidance released in 2018; 
  • Waiver concepts that incorporate the entire range of waivable requirements allowed under section 1332; and
  • How states might combine the flexibilities available under 1332 with other flexibilities that exist under federal law, including regulatory flexibility, Section 1115 Medicaid waivers, as well as state law. 

Comments for the RFI are due by July 2, 2019.”