How Waivers Work: ACA Section 1332 and Medicaid Section 1115

UMMS Affiliation

Commonwealth Medicine, Center for Health Law and Economics

Publication Date


Document Type

Technical Report


Health Economics | Health Law and Policy | Health Policy | Health Services Administration | Health Services Research


Many health care programs, including Medicaid and Affordable Care Act (ACA) health insurance marketplaces, operate according to federal law. Using waivers, states can gain federal approval to increase their flexibility within that law.

States have long used Medicaid Section 1115 waivers to manage their Medicaid programs. The ACA introduced the State Innovation Waiver, also known as a Section 1332 waiver, which can be used to waive many health insurance marketplace requirements.

This brief outlines how Medicaid Section 1115 and ACA Section 1332 waivers work and what states should consider when designing these waivers.

Journal/Book/Conference Title

Commonwealth Medicine Publications