Section 1332 State Innovation Waivers

The Honorable Sylvia Burwell
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201

The Honorable Jacob Lew
U.S. Department of the Treasury
1500 Pennsylvania Avenue, NW
Washington, DC 20220

Dear Secretary Burwell and Secretary Lew:

On behalf of the nation’s governors, we urge you to provide states with the guidance and flexibility needed to pursue Section 1332 state innovation waivers (1332 waivers). Section 1332 of the Affordable Care Act allows states to waive certain provisions of the law starting in 2017, but as yet the federal government has provided minimal guidance to states interested in using that authority to design alternative coverage approaches. Meaningful guidance that maximizes state flexibility is critical to supporting governors as they consider innovative ways to provide affordable coverage in the context of local markets.

In June, the National Governors Association Center for Best Practices (NGA Center) convened a group of state leaders, senior federal officials and other national experts to identify opportunities and challenges associated with 1332 waivers. The discussion focused on budget-neutral financing and communication between states and the federal government regarding waiver concepts. Participating states, which represented the full spectrum of coverage models, also highlighted opportunities for the federal government to streamline the review and approval process for waiver applications. Governors appreciated the participation of your agencies in the NGA Center roundtable and seek to build on that dialogue by presenting the attached recommendations for facilitating state innovation through Section 1332.

Section 1332 offers governors the chance to work with their state agencies and stakeholders to pursue innovative coverage and delivery system initiatives tailored to the unique needs of their states. We look forward to working with you to ensure states have the flexibility and information needed to take full advantage of this opportunity.


Governor Charlie Baker
NGA Health and Human Services Committee

Governor Maggie Hassan
Vice Chair
NGA Health and Human Services Committee