CMS Seeks Additional Information on Georgia’s Sec. 1332 Waiver Application


On February 6, 2020, the Centers for Medicare & Medicaid Services (CMS) sent a letter to Georgia Gov. Brian Kemp, announcing that the reinsurance portion of Georgia’s 1332 waiver application is complete. The announcement allows the agency to begin the 180-day notice-and-comment period on that section of Georgia’s waiver application. However, CMS paused its preliminary review of the other portion of the application, which would make significant changes to the state’s health insurance marketplace. These changes are problematic for multiple reasons and could make health insurance plans cost-prohibitive for a significant portion of Georgia’s population, including many who are currently insured.

In the letter, CMS announced that it would not review the remaining sections of the state’s waiver application until it receives additional information about how the waiver application will satisfy the four Sec. 1332 guardrails set forth in the Patient Protection and Affordable Care Act (ACA). These guardrails require states that are requesting a Sec. 1332 waiver to:

  • Provide coverage that is at least as comprehensive as the coverage defined in Section 1302(b) and offered through Exchanges;
  • Provide coverage and cost-sharing protections against excessive out-of-pocket spending that are at least as affordable as the provisions of this title would provide;
  • Provide coverage to at least a comparable number of its residents as the provisions of this title would provide; and
  • Not increase the federal deficit.

See our previous post on this topic for more information on Georgia’s initial request and the arguments against the proposed changes.

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