The Centers for Medicare & Medicaid Services has introduced four new “state relief and empowerment waivers” that are widely viewed as new vehicles for states to circumvent Affordable Care Act requirements to implement their own new approaches to health care.
- Through “account-based subsidies” waivers, states may direct public subsidies into defined-contribution, consumer-directed accounts that individuals use to pay for health insurance premiums or other health care expenses.
- “State-specific premium assistance” waivers enable states to create their own subsidy programs.
- “Adjusted plan options” authorizes states to provide financial assistance for different types of health insurance plans, including short-term and other health insurance policies that do not meet Affordable Care Act benefits and coverage requirements.
- “Risk stabilization strategies” waivers give states greater flexibility to implement reinsurance programs or high-risk pools.
These waiver options have been introduced not through regulations but through guidance published in the Federal Register. States must apply for these waivers, which must meet section 1332 federal standards for comprehensiveness, affordability, coverage, and federal deficit neutrality.