Ohio’s Application for PPACA State Innovation Waiver Denied

Ohio’s application for a State Innovation Waiver under section 1332 of the Patient Protection and Affordable Care Act (PPACA) was recently denied. Ohio was specifically seeking to waive the “individual mandate.”* Per federal guidelines (see 45 C.F.R. 155.1308(c)), the application was reviewed by the U.S. Department of Health and Human Services and the U.S. Department of the Treasury (hereinafter “the Departments”). The Departments found the application to be incomplete, as communicated to the Ohio Department of Insurance in a 5/17/18 letter from Randy Pate, Director of the Center for Consumer Information & Insurance Oversight (CCIIO) and Deputy Administrator of the Centers for Medicare & Medicaid Services. Specifically, the Ohio application did “not include a description of any program implementing a waiver plan for providing coverage that meets section 1332 requirements,” and did not include a description of the reason Ohio was seeking to waive the “individual mandate.” [See requirements detailed at 42 U.S.C. 18052 and 45 C.F.R. 155.1308(f)(3)(iii).] The CCIIO oversees the implementation of PPACA provisions related to private health insurance, including Section 1332 State Innovation Waivers, which permit a state to “pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA.” After the Departments make a preliminary determination that a State Innovation Waiver application is complete, they provide for a public notice and comment period, and make a final decision on the application within 180 days.

*The “individual mandate” was originally codified at 26 U.S.C. §5000A and 26 C.F.R. 1.5000A-2. The Tax Cuts and Jobs Act (Pub. L. No. 115-97, 131 Stat. 2054, 12/22/17; text not yet available – see Section 11081 of H.R. 1, 115th Cong., 2017) repealed §5000A and eliminated the penalty associated with the individual mandate, beginning in 2019. However, no changes were made to the statutory language that established the mandate. For more information, see The Individual Mandate for Health Insurance Coverage: In Brief, by the Congressional Research Service.