A recent Idaho bulletin on requirements for state-based health plans in the individual market “may not be substantially enforcing provisions” of the Affordable Care Act, the Centers for Medicare & Medicaid Services told Gov. Butch Otter yesterday. “If a state fails to substantially enforce the law, [CMS] has a responsibility to enforce these provisions on behalf of the state,” wrote CMS Administrator Seema Verma. “This is certainly not our preference; we believe that Idaho has options within the law to meaningfully implement many of the policy proposals contained in the bulletin, to address the crisis facing the state’s individual health insurance market.” In a statement, Verma said CMS “looks forward to continuing to work with Idaho on their 1332 and 1115 waiver applications.”