§18052 Waiver for State innovation

Summary

A State can ask the federal government for permission to run its own health insurance plan instead of following certain federal rules. The state must file an application when and how the Secretary requires, describe the state law and program that will run the plan, include a 10-year budget plan that is budget neutral for the Federal Government, and show it has passed the needed state law. The waiver can cover specific parts of the health law and certain tax rules listed in the statute (including parts A and B of the subchapter, section 18071, and tax code sections 36B, 4980H, and 5000A) for plan years beginning January 1, 2014, while waivers are available for plan years starting January 1, 2017. If the state plan means people or small employers would not get premium tax credits, cost-sharing reductions, or small-business credits they otherwise would, the Secretary will instead send the total amount that would have gone to those people to the state each year; the Secretary decides that amount annually. The Secretary must make rules for the waiver process within 180 days after March 23, 2010 that include public notice, state hearings, clear application steps, state reporting, and regular federal review. The Secretary will try to let a state submit one combined application for related federal health program waivers. “Secretary” means the HHS Secretary for the health-law waivers and the Treasury Secretary for the tax-law waivers. A waiver can only be approved if the state plan gives coverage as comprehensive and as affordable as the federal rules, covers at least as many people, and does not increase the federal deficit. The Secretary must decide on an application within 180 days, tell the state the terms if approved, or notify the state and Congress and explain why if denied. Waivers last up to 5 years; a state may ask to continue a waiver and that request is treated as granted unless the Secretary denies it or asks for more information within 90 days.