1332 State Innovation Waivers (93.423)
1332 State Innovation Waivers (Assistance Listing 93.423) is run by the Centers for Medicare and Medicaid Services, part of the Department of Health and Human Services. It awarded $36 billion in 19 grants from fiscal 2021 to 2025, about $1.9 billion per award on average. No funding opportunity is open on Grants.gov right now.
The typical award was $599 million. Half of the 19 awards fell between $206 million and $1.3 billion, and they ranged from $232,042 to $22 billion.
- Awarded, FY 2021 to 2025$36 billion
- Grant awards19
- Typical award$599 million
- Awarded in FY 2025$16 billion
- Size rank17 of 1,823
- Type of assistanceCooperative agreements
Key findings
- Annual funding rose from $1.7 billion in fiscal 2021 to $16 billion in fiscal 2025.
- It is the 17th largest of 1,823 federal grant programs by five-year awards.
- The 19 largest recipients received 100% of the money.
- Awards went to recipients in 19 states and territories.
What the program funds
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.
Open opportunities
No opportunity under this program is open or forecast on Grants.gov right now. Programs often post once a year, so the funding history below shows what to expect.
Rules from the program listing
Who can apply
This funding opportunity is only open to US States, Territories and Possessions.
What the money can and cannot pay for
Federal pass-through funding made available through a section 1332 waiver must be used only to implement the waiver program. The amount of federal pass-through funding equals the Departments’ annual estimate of the federal financial assistance, including premium tax credits (PTC), small business tax credits, or cost-sharing reductions, provided pursuant to the ACA that would have been paid on behalf of participants in the Exchange in the state in the calendar year in the absence of the waiver, but will not be paid as a result of the waiver. The pass-through funds cannot be obligated by the state prior to the waiver effective date. The state agrees to use the full amount of pass-through funding for purposes of implementing the state’s plan as approved by the Departments. To the extent any pass-through funding exceeds the amount necessary to implement the waiver program, the remaining funds must be rolled over and used for purposes of implementing the state’s plan under the waiver. If the waiver is not extended or amended, or is suspended or terminated, unused pass-through funds will be returned to the Treasury promptly, and the state will comply with all the necessary steps to do so. Federal passthrough funding made available through Section 1332 must be used only to implement the waiver program. The passthrough funds cannot be obligated by the state prior to the waiver effective date.
Matching requirements
This program has no statutory formula. Matching requirements are not applicable to this assistance listing. This program has MOE requirements, see funding agency for further details. Maintenance of Effort requirements, as applicable, will be detailed in a grantee’s STCs document. States will only receive federal pass-through funding assistance to which it has been calculated they are entitled in accordance with statutory and regulatory requirements, and are expected to supplement any remaining costs of the waiver program with state and/or other funding sources.
Deadlines
Contact the headquarters or regional location, as appropriate for application deadlines
Award range and average, in the agency's words
TBD
Examples of funded projects
Fiscal Year2016: N/AFiscal Year2017: Alaska 1332 Waiver Program request to establish a state-re-insurance program Hawaii 1332 Waiver Program request to waive key SHOP requirements to implement the Hawaii Prepaid Healthcare Act Fiscal Year2018: Hawaii Small Business Health Options Program (SHOP) Waiver Program, Alaska Reinsurance Waiver Program, Minnesota Reinsurance Waiver Program, Oregon Reinsurance Waiver Program.Fiscal Year2024: Hawaii Small Business Health Options Program (SHOP) Waiver Program, Alaska Reinsurance Program, Minnesota Reinsurance Program, Oregon Reinsurance Program,. Maine Reinsurance Program, Maryland Reinsurance Program, New Jersey Reinsurance Program, Wisconsin Reinsurance Program, Colorado Reinsurance Program, Delaware Reinsurance Program, Montana Reinsurance Program, North Dakota Reinsurance Program, Rhode Island Reinsurance Program, Pennsylvania Reinsurance Program, New Hampshire Reinsurance Program, Georgia Reinsurance Program, Virginia Reinsurance Program, Idaho Individual High Risk Reinsurance Pool, New York Essential Plan Expansion Program.
Funding history and past recipients
From fiscal 2021 to 2025, 1332 State Innovation Waivers (93.423) awarded $36 billion across 19 grant awards, an average of $1.9 billion per award.
Who usually wins
Almost all of the money went to state and local governments.
| Recipient type | Awards | Amount | Share |
|---|---|---|---|
| State and local governments | 19 | $36 billion | 100% |
By state
18 states have a page for this program: those that received at least $1 million or 10 awards.
| State | Awards | Amount |
|---|---|---|
| New York | 1 | $22 billion |
| Georgia | 1 | $2.6 billion |
| Maryland | 1 | $2.4 billion |
| New Jersey | 1 | $2.1 billion |
| Colorado | 1 | $1.3 billion |
| Virginia | 1 | $1.3 billion |
| Wisconsin | 1 | $1.0 billion |
| Minnesota | 1 | $663 million |
| Pennsylvania | 1 | $646 million |
| Alaska | 1 | $599 million |
| Oregon | 1 | $376 million |
| Idaho | 1 | $298 million |
| Maine | 1 | $236 million |
| Delaware | 1 | $235 million |
| Montana | 1 | $177 million |
| New Hampshire | 1 | $152 million |
| North Dakota | 1 | $113 million |
| Rhode Island | 1 | $54.7 million |
| Hawaii | 1 | $232,042 |