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Section 1332 State Innovation Waivers, named after the section of the Affordable Care Act (ACA) that created them, are intended to allow states to implement innovative or alternative

strategies to achieve health coverage. As of early September 2019, thirteen states have had State Innovation Waivers approved.  While State Innovation Waivers can help improve the market and

lower premiums, they can also cause harm if used the wrong way. Recent changes in federal guidance could have potentially negative impact on access and affordability of health coverage for

older adults. All states, whether or not they plan to pursue State Innovation Waivers in the future, should have a sound understanding of these waivers and the implications of recent federal

and state changes to these waivers. States considering waivers in the future can look to other states that have successfully implemented waivers for promising practices to improve access to

and affordability of coverage for older adults.  This latest Insight on the Issues highlights five key steps that states should take to understand and evaluate the impact of State

Innovation Waivers on older adults: 1) Learn how a State Innovation Waiver works 2) Recognize opportunities to improve coverage: reinsurance and other state waivers 3) Approach recent

federal guidance with caution: protecting older adults 4) Understand the waiver process and public input opportunities 5) Keep an eye on federal activity