The Centers for Medicare & Medicaid Services last week rejected a request from Idaho for a state innovation waiver under Section 1332 of the Affordable Care Act, saying the agency did not have enough information to evaluate the application. Idaho wanted to allow low-income residents who qualify for Medicaid under the state’s expansion to instead stay on the state's health insurance exchange. The state had sought waivers to modify the eligibility criteria for the premium tax credit and cost-sharing reductions to permit residents with income between 100% and 133% of the federal poverty level to qualify for these federal subsidies regardless of their underlying eligibility for Medicaid, provided they are not enrolled in Medicaid. CMS said “even if the application were revised to include the correct elements, Idaho’s application would not be approvable because it could not demonstrate compliance with the statutory guardrails, in particular the deficit neutrality guardrail.”

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