New ACA Innovation Waiver Policy Brings Major Changes to State Marketplace Coverage

The Centers for Medicare and Medicaid Services (CMS) unveiled a controversial policy last month that expanded what’s permissible under §1332 waivers, which states can submit to be exempt from certain requirements under the Affordable Care Act (ACA).

CMS Administrator Seema Verma followed up on this guidance by announcing four “waiver concepts,” specific examples of actions states can do to restructure marketplace plans.

states can: (1) create and contribute to accounts for consumers’ premium and out-of-pocket expenses, (2) restructure subsidy eligibility, (3) redefine what plans qualify for subsidies and (4) implement high-risk pools.