Now that the vote on the American Healthcare Act has been withdrawn, and its return highly unlikely, it would appear that the Affordable Care Act will continue to be the law of the land indefinitely. But that does not mean that states won’t continue to make their own healthcare rules on a local level. States can do so using the Section 1332 Waiver process. The Department of Health and Human Services (HHS) and the Centers For Medicare & Medicaid Services (CMS) have recently sent letters to state governors to encourage them to do so.
The first “Dear Governor” letter was dated March 13, urging the filing of IRS Section 1332, State Innovation Waivers. These waivers signify that states can implement their own healthcare platforms, pending approval from the ACA. Hawaii has been successful in a fully functioning state-implemented healthcare platform, and Alaska is on the horizon. The aforementioned letter referenced the latter state and their pursuit of a better state-run marketplace.
The second “Dear Governor” letter came the following day on March 14 and centered around Medicaid expansion within states, urging states to take more control of the Medicaid program and relying less on a federal level. This is in line with the concept of having states make key decisions surrounding their own health programs, their implementation of Medicaid being one of them.
While emphasizing that states should put taxpayer dollars to good use with the “truly vulnerable,” other tips were provided. These included hiring low-income non-disabled employees and initiating skill-building programs for them, completing waivers that require non-emergency medical transport for everyone but pregnant women and the elderly, as well as waivers presuming insurance eligibility or retroactive health coverage which would greatly affect hospital visits.
Finally, the second letter urges states to run Medicaid like an insurance company, complete with premiums, HSAs, and even copayments. While Medicare wasn’t referenced, it will more than likely come up in the near future.
The CMS expressed streamlining Section 1332 waivers in their letter, along with support for any states looking to act but requiring guidance.
