1. 2016

   N/A

2. 2017

   It is expected that 4 requests and 2 awards will be made in FY17.

3. 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.

4. 2024

   CCIIO awarded nineteen states (AK, CO, DE, GA, HI, ID, ME, MD, MN, MT, ND, NH, NJ, NY, OR, PA, RI, VA, WI) grant funds in 2024.

Single Audit Applies (2 CFR Part 200 Subpart F):

For additional information on single audit requirements for this program, review the current Compliance Supplement.

Regulations governing the application process for State Innovation Waivers can be found at the Federal Register at: 77 Fed. Reg. 11700 (Feb. 27, 2012); 80 Fed. Reg. 78131 (Dec. 16, 2015; ‘2015 Guidance’); 83 Fed. Reg. 53575 (Oct. 24, 2018; ‘2018 Guidance’); 85 Fed. Reg. 71142 (Nov. 6, 2020); 85 Fed. Reg. 78572 (Dec. 4, 2020); 86 Fed. Reg. 6138 (Jan. 19, 2021); 86 Fed. Reg. 53412 (Sept. 27, 2021); 89 Fed. Reg. 26229 (Apr. 15, 2024). 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 the Departments have determined an application is complete. The regulations also describe the requirements for post-award reporting and the standards under which post-award monitoring will take place. Additionally, the regulations describe the requirements for waiver extension requests and amendments. On February 27, 2012, the Departments promulgated final implementing regulations for the section 1332 waiver application and review process. On July 15, 2019, CMS published a section 1332 waiver checklist to help states develop and complete application requirements. This checklist itemized the elements required for a waiver application, including information about waiver concepts and citations to relevant regulatory provisions. On November 6, 2020, the Departments published an interim final rule with request for comments (85 FR 71142, November 2020 IFC), which revised regulations to set forth flexibilities in the public notice requirements and post-award public participation requirements for waivers under section 1332 during the COVID-19 PHE. On September 27, 2021, the Departments published the final rule “Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond” as part 3 of the HHS Notice of Benefit and Payment Parameters for 2022 (part 3 of the 2022 Payment Notice final rule), which supersedes and replaces the policies and interpretations outlined in the prior, 2018 guidance. The Departments finalized modifications to implementing regulations governing section 1332 waivers, including changes to many of the policies and interpretations of the statutory guardrails codified in part 1 of the 2022 Payment Notice final rule. The final rule also repealed and replaced the previous codification of the 2018 guidance’s guardrail interpretations in part 1 of the 2022 Payment Notice final rule. The interpretations of the statutory guardrails finalized as part of this final rule are largely in line with the guardrail interpretations in the 2015 Guidance. With respect to the statutory guardrails, the Departments finalized that they will interpret the words “provide” and “coverage” to mean the same thing for the coverage, comprehensiveness, and affordability guardrails, and that, to be approved, a waiver must be projected to provide coverage that is as comprehensive and affordable as would have been provided absent the waiver and to the same number of residents. Waivers must also continue not to increase the federal deficit. The Departments modified regulations in order to provide flexibilities in the public notice requirements and post-award public participation requirements for section 1332 waivers under future emergent circumstances, if certain criteria are met. The final rule also provided new information regarding the processes and procedures for amendments and extensions of approved section 1332 waivers. On April 15, 2024, the Departments published the final rule “Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2025; Updating Section 1332 Waiver Public Notice Procedures; Medicaid; Consumer Operated and Oriented Plan (CO-OP) Program; and Basic Health Program.” This final rule updated state public notice and comment procedures to allow states to hold public hearings and post-award forums in virtual, in-person, or hybrid formats. States must still hold two distinct public hearings; however, under this rule one or both hearings may be conducted virtually or in a hybrid format. The Departments offered this flexibility to states due to increased access to virtual meeting technology, improved geographic accessibility, and lessons learned during the public health emergency.

1. The Affordable Care Act, Section 1332.