Trump Administration announces State Relief and Empowerment Waivers to give states flexibility to lower health insurance premiums and increase choices

From the Office of the Regional Director

Matt Baker


Delaware | District of Columbia | Maryland  | Pennsylvania | Virginia | West Virginia

Dear Partners,

The Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of the Treasury (collectively, the Departments) have released new guidance related to section 1332 of the Patient Protection and Affordable Care Act (PPACA). This action is being taken so states can increase choice and competition within their insurance market while protecting people with pre-existing conditions.

The new guidance gives states more flexibility to address problems caused by the PPACA and to give Americans more options to get health coverage that better meets their needs. Under this new policy, states will be able to pursue waivers to improve their individual insurance markets, increase affordable coverage options for their residents, and ensure that people with pre-existing conditions are protected. These waivers are now called State Relief and Empowerment Waivers to reflect this new direction and opportunity.

The guidance issued today is intended to loosen excessive restrictions that limit state flexibility and consumer choice while maintaining the requirements of the statute, and provide flexibility for states to meet the state legislative authority requirement. States are required under the statute to enact a law providing for implementation of the Waiver. The guidance clarifies that in certain circumstances, existing state legislation that provides statutory authority to enforce PPACA provisions and the state waiver plan, combined with a duly-enacted state regulation or executive order, may satisfy the requirement that the state enact a law.

The Departments urge states to consider this new guidance as an opportunity to develop strategies that best suit their individual needs. Through innovative actions, tailored to specific state circumstances, states can lower premiums for consumers, improve markets, and increase consumer choice. The Departments are committed to empowering states to innovate in ways that will strengthen their health insurance markets and meet the unique needs of every state.

To view the CMS press release, please visit the CMS Newsroom here.

To view the guidance, please visit this link.

To view the CMS 1332 fact sheet, please visit here.

To view CMS’ “Dear Governor” letter, visit here.

If you have any questions, please contact me at 215-861-4648 or at