The U.S. Departments of Health and Human Services (HHS) and Treasury have proposed new rules to guide states in pursuing "State Innovation Waivers" under the Patient Protection and Affordable Care Act (PPACA). PPACA allows states that receive waivers to implement their own insurance schemes so long as they:

  • Provide coverage that is at least as comprehensive as that offered through the health insurance exchanges that are expected to begin operating in 2014.
  • Make coverage at least as affordable as it would have been through the exchanges.  
  • Provide coverage to at least as many residents as otherwise would have been covered under PPACA.
  • Do not increase the federal deficit.  

Under PPACA, states already have significant flexibility in how to provide coverage to their residents, including the design of insurance exchanges and the choices of plans and benefits to be offered through them.A government website spells out the options and the federal resources and is available by clicking here.

The new proposed regulation describes the content of the waiver application and how such proposals would be communicated to the public and evaluated. The proposed effective date is 2017, but the government has suggested that it would support pushing it up to 2014.