# 1332 State Innovation Waivers (93.423)

Source: https://welltoldgrants.com/programs/93-423-1332-state-innovation-waivers/  
Publisher: Well Told Grants. Data: USAspending.gov and Grants.gov, updated November 7, 2026.

1332 State Innovation Waivers is run by Department of Health and Human Services. From fiscal 2021 to 2025 it awarded $36 billion in 19 grants, about $1.9 billion per award.

## Objectives

Under Section 1332 of the ACA, states can apply for State Innovation Waivers (also referred to as section 1332 waivers) and pursue innovative strategies to adapt many of the law's requirements to suit the state's specific needs. To receive approval, the state must demonstrate that a proposed section 1332 waiver meets the statutory guardrails to provide coverage that is at least as comprehensive as the coverage provided without the waiver; provides coverage and cost-sharing protections against excessive out-of-pocket spending that are at least as affordable as without the waiver; provides coverage to at least a comparable number of residents as without the waiver; and does not increase the federal deficit. Before submitting its section 1332 waiver application the state must also provide a public notice and comment period, including public hearings, sufficient to ensure a meaningful level of public input, and enact a law providing for implementation of the waiver. Under a section 1332 waiver, a state may receive pass-through funding associated with the resulting reductions in federal spending on Exchange financial assistance consistent with the statute.

## Funding by fiscal year

| Year | Amount | Awards |
|---|---|---|
| 2021 | $1.7 billion | 15 |
| 2022 | $1.9 billion | 16 |
| 2023 | $2.8 billion | 18 |
| 2024 | $14 billion | 19 |
| 2025 | $16 billion | 19 |

## Largest recipients

| Recipient | State | Amount |
|---|---|---|
| NYS Department of Health | New York | $22 billion |
| Department of Insurance of the State of Georgia | Georgia | $2.6 billion |
| Maryland Health Benefit Exchange | Maryland | $2.4 billion |
| New Jersey Department of Banking and Insurance | New Jersey | $2.1 billion |
| Colorado Department of Regulatory Agencies | Colorado | $1.3 billion |
| State Corporation Commission | Virginia | $1.3 billion |
| State of Wisconsin Commissioner of Insurance | Wisconsin | $1.0 billion |
| Department of Commerce Minnesota | Minnesota | $663 million |
| Pennsylvania Department of Insurance | Pennsylvania | $646 million |
| AK Department of Commerce Community Econo | Alaska | $599 million |
| Department of Consumer & Business Services | Oregon | $376 million |
| Idaho Individual High Risk Reinsurance Pool | Idaho | $298 million |
| Maine Guaranteed Access Reinsurance Association | Maine | $236 million |
| Health and Social Services, Department of | Delaware | $235 million |
| State Auditor Montana | Montana | $177 million |
| New Hampshire Individual Health Plan Benefit Association | New Hampshire | $152 million |
| Insurance North Dakota Department of | North Dakota | $113 million |
| Executive Department of the State of Rhode Island | Rhode Island | $54.7 million |
| State of Hawaii Department of Labor and Industrial Relations | Hawaii | $232,042 |