In the absence of federal legislation, states are actively seeking tools to reform their health care systems. While 1115 waivers rightly get a lot of attention, because of their ability to reshape state Medicaid programs, the Affordable Care Act’s Section 1332 waivers continue to be a promising avenue for states to stabilize their health insurance marketplace. SHVS is tracking state activity and has many resources, including a template, for states interested in pursuing a Section 1332 waiver.
Federally-Facilitated Exchanges and the Continuum of State Options
Manatt Health Solutions – Deborah Bachrach and Patricia Boozang
The Affordable Care Act allows states to create their own state-based health insurance exchanges or to allow a federally facilitated exchange to operate in the state. Proposed rules from the Department of Health and Human Services (HHS) also allow a partnership model where the federal and state governments share in the execution of exchange functions. This brief, supported by the State Network and published by the National Academy for Social Insurance, explores the continuum of options for states from fully state-based to fully federally facilitated, evaluating the considerations and implications associated with each option to help states determine which model may work best for the unique needs of their residents. The authors conclude that regardless of the model chosen, success can only be achieved through intensive collaboration between individual states and HHS.