Assistance program
1332 State Innovation Waivers
$46.8 Billion committed in FY2018–FY2026
- Agency
- Centers for Medicare and Medicaid Services, Health and Human Services, Department of
- Assistance
- Cooperative Agreements
- CFDA number
- 93.423
- What it does
- 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.
- Who benefits
- N/A
- Who applies
- This funding opportunity is only open to US States, Territories and Possessions.
- Authorized by
- The Affordable Care Act, Section 1332
Committed by fiscal year
* FY2026 is year-to-date — the fiscal year is still in progress, so its total is still filling in. The striped band and dashed line mark that provisional stretch.
Top recipients
By dollars committed.
How to read these numbers
- Committed through this program
Money committed under this assistance listing (its CFDA program), counted in the year each action happened.
- How it's paid
Most programs pay out one way — a grant, or a direct payment to individuals; the flow bar only appears when a program genuinely mixes types.
- Some recipients aren't itemized
For entitlement programs like Social Security and Medicare, the government reports one aggregate instead of naming tens of millions of people, so the recipient roster isn't part of the public record.
- Awards, counted once
An award count is the number of distinct awards with at least one action that year — each counted once, however many times it was amended.
- The colored bars
Every bar on this page splits by how the money moves:
Direct payments