How Waivers Work: ACA Section 1332 and Medicaid Section 1115

Many health care programs, including Medicaid and Affordable Care Act (ACA) health insurance marketplaces, operate according to federal law. Using waivers, states can gain federal approval to increase their flexibility within that law.

States have long used Medicaid Section 1115 waivers to manage their Medicaid programs. The ACA introduced the State Innovation Waiver, also known as a Section 1332 waiver, which can be used to waive many health insurance marketplace requirements.

This brief outlines how Medicaid Section 1115 and ACA Section 1332 waivers work and what states should consider when designing these waivers.

For consideration of how Connecticut could use waivers to improve health care affordability and access, see companion brief “Using Waivers to Improve Health Care Affordability and Access to Coverage in Connecticut.”

Authors

Robert W. Seifert, MPA, is a principal with the UMass Medical School Center for Health Law and Economics

Rachel Gershon, JD, MPH is a senior research policy analyst with the UMass Medical School Center for Health Law and Economics

Katharine London, MS, is a principal with the UMass Medical School Center for Health Law and Economics

This publication was funded by the Connecticut Health Foundation in partnership with the Universal Health Care Foundation of Connecticut