---
kind: "section"
citation: "42 U.S.C. § 18052"
title: "42"
title_heading: "The Public Health and Welfare"
number: "18052"
heading: "Waiver for State innovation"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/18052"
units:
  - "Chapter 157 — Quality, Affordable Health Care for All Americans"
  - "Subchapter III — Available Coverage Choices for All Americans"
  - "Part D — State Flexibility To Establish Alternative Programs"
---

# §18052. Waiver for State innovation

- (a) **Application—**
  - (1) **In general—** A [State](/usc/42/18024.md?p=d) may apply to the [Secretary](/usc/42/18024.md?p=c) for the waiver of all or any requirements described in [paragraph (2)](#a-2) with respect to [health insurance coverage](/usc/42/18021.md?p=b-2) within that [State](/usc/42/18024.md?p=d) for plan years beginning on or after January 1, 2017. Such application shall—
    - (A) be filed at such time and in such manner as the [Secretary](/usc/42/18024.md?p=c) may require;
    - (B) contain such information as the [Secretary](/usc/42/18024.md?p=c) may require, including—
      - (i) a comprehensive description of the [State](/usc/42/18024.md?p=d) legislation and program to implement a plan meeting the requirements for a waiver under this section; and
      - (ii) a 10-year budget plan for such plan that is budget neutral for the Federal Government; and
    - (C) provide an assurance that the [State](/usc/42/18024.md?p=d) has enacted the law described in [subsection (b)(2)](#b-2).
  - (2) **Requirements—** The requirements described in this paragraph with respect to [health insurance coverage](/usc/42/18021.md?p=b-2) within the [State](/usc/42/18024.md?p=d) for plan years beginning on or after January 1, 2014, are as follows:
    - (A) Part A of this subchapter.
    - (B) Part B of this subchapter.
    - (C) [Section 18071 of this title](/usc/42/18071.md).
    - (D) Sections 36B, 4980H, and 5000A of title 26.
  - (3) **Pass through of funding—** With respect to a [State](/usc/42/18024.md?p=d) waiver under [paragraph (1)](#a-1), under which, due to the structure of the [State](/usc/42/18024.md?p=d) plan, individuals and [small employers](/usc/42/18024.md?p=b-2) in the [State](/usc/42/18024.md?p=d) would not qualify for the premium tax credits, cost-sharing reductions, or small business credits under sections[^1] [36B](/usc/26/36B.md) of title 26 or under part I of subtitle E for which they would otherwise be eligible, the [Secretary](/usc/42/18024.md?p=c) shall provide for an alternative means by which the aggregate amount of such credits or reductions that would have been paid on behalf of participants in the Exchanges established under this title[^2] had the [State](/usc/42/18024.md?p=d) not received such waiver, shall be paid to the [State](/usc/42/18024.md?p=d) for purposes of implementing the [State](/usc/42/18024.md?p=d) plan under the waiver. Such amount shall be determined annually by the [Secretary](/usc/42/18024.md?p=c), taking into consideration the experience of other [States](/usc/42/18024.md?p=d) with respect to participation in an Exchange and credits and reductions provided under such provisions to residents of the other [States](/usc/42/18024.md?p=d).
  - (4) **Waiver consideration and transparency—**
    - (A) **In general—** An application for a waiver under this section shall be considered by the [Secretary](/usc/42/18024.md?p=c) in accordance with the regulations described in [subparagraph (B)](#a-4-B).
    - (B) **Regulations—** Not later than 180 days after March 23, 2010, the [Secretary](/usc/42/18024.md?p=c) shall promulgate regulations relating to waivers under this section that provide—
      - (i) a process for public notice and comment at the [State](/usc/42/18024.md?p=d) level, including public hearings, sufficient to ensure a meaningful level of public input;
      - (ii) a process for the submission of an application that ensures the disclosure of—
        - (I) the provisions of law that the [State](/usc/42/18024.md?p=d) involved seeks to waive; and
        - (II) the specific plans of the [State](/usc/42/18024.md?p=d) to ensure that the waiver will be in compliance with [subsection (b)](#b);
      - (iii) a process for providing public notice and comment after the application is received by the [Secretary](/usc/42/18024.md?p=c), that is sufficient to ensure a meaningful level of public input and that does not impose requirements that are in addition to, or duplicative of, requirements imposed under the Administrative Procedures Act,[^2] or requirements that are unreasonable or unnecessarily burdensome with respect to [State](/usc/42/18024.md?p=d) compliance;
      - (iv) a process for the submission to the [Secretary](/usc/42/18024.md?p=c) of periodic reports by the [State](/usc/42/18024.md?p=d) concerning the implementation of the program under the waiver; and
      - (v) a process for the periodic evaluation by the [Secretary](/usc/42/18024.md?p=c) of the program under the waiver.
    - (C) **Report—** The [Secretary](/usc/42/18024.md?p=c) shall annually report to Congress concerning actions taken by the [Secretary](/usc/42/18024.md?p=c) with respect to applications for waivers under this section.
  - (5) **Coordinated waiver process—** The [Secretary](/usc/42/18024.md?p=c) shall develop a process for coordinating and consolidating the [State](/usc/42/18024.md?p=d) waiver processes applicable under the provisions of this section, and the existing waiver processes applicable under titles XVIII, XIX, and XXI of the Social Security Act [[42 U.S.C. 1395](/usc/42/1395.md) et seq., 1396 et seq., 1397aa et seq.], and any other Federal law relating to the provision of health care items or services. Such process shall permit a [State](/usc/42/18024.md?p=d) to submit a single application for a waiver under any or all of such provisions.
  - (6) **Definition—** In this section, the term “[Secretary](/usc/42/18024.md?p=c)” means—
    - (A) the [Secretary](/usc/42/18024.md?p=c) of Health and Human Services with respect to waivers relating to the provisions described in subparagraph [(A)](#a-2-A) through [(C)](#a-2-C) of paragraph (2); and
    - (B) the [Secretary](/usc/42/18024.md?p=c) of the Treasury with respect to waivers relating to the provisions described in [paragraph (2)(D)](#a-2-D).
- (b) **Granting of waivers—**
  - (1) **In general—** The [Secretary](/usc/42/18024.md?p=c) may grant a request for a waiver under [subsection (a)(1)](#a-1) only if the [Secretary](/usc/42/18024.md?p=c) determines that the [State](/usc/42/18024.md?p=d) plan—
    - (A) will provide coverage that is at least as comprehensive as the coverage defined in [section 18022(b) of this title](/usc/42/18022.md?p=b) and offered through Exchanges established under this title[^2] as certified by Office[^3] of the Actuary of the Centers for Medicare & Medicaid Services based on sufficient data from the [State](/usc/42/18024.md?p=d) and from comparable [States](/usc/42/18024.md?p=d) about their experience with programs created by this Act and the provisions of this Act that would be waived;
    - (B) will provide coverage and cost sharing protections against excessive out-of-pocket spending that are at least as affordable as the provisions of this title[^2] would provide;
    - (C) will provide coverage to at least a comparable number of its residents as the provisions of this title[^2] would provide; and
    - (D) will not increase the Federal deficit.
  - (2) **Requirement to enact a law—**
    - (A) **In general—** A law described in this paragraph is a [State](/usc/42/18024.md?p=d) law that provides for [State](/usc/42/18024.md?p=d) actions under a waiver under this section, including the implementation of the [State](/usc/42/18024.md?p=d) plan under [subsection (a)(1)(B)](#a-1-B).
    - (B) **Termination of opt out—** A [State](/usc/42/18024.md?p=d) may repeal a law described in [subparagraph (A)](#b-2-A) and terminate the authority provided under the waiver with respect to the [State](/usc/42/18024.md?p=d).
- (c) **Scope of waiver—**
  - (1) **In general—** The [Secretary](/usc/42/18024.md?p=c) shall determine the scope of a waiver of a requirement described in [subsection (a)(2)](#a-2) granted to a [State](/usc/42/18024.md?p=d) under [subsection (a)(1)](#a-1).
  - (2) **Limitation—** The [Secretary](/usc/42/18024.md?p=c) may not waive under this section any Federal law or requirement that is not within the authority of the [Secretary](/usc/42/18024.md?p=c).
- (d) **Determinations by Secretary—**
  - (1) **Time for determination—** The [Secretary](/usc/42/18024.md?p=c) shall make a determination under [subsection (a)(1)](#a-1) not later than 180 days after the receipt of an application from a [State](/usc/42/18024.md?p=d) under such subsection.
  - (2) **Effect of determination—**
    - (A) **Granting of waivers—** If the [Secretary](/usc/42/18024.md?p=c) determines to grant a waiver under [subsection (a)(1)](#a-1), the [Secretary](/usc/42/18024.md?p=c) shall notify the [State](/usc/42/18024.md?p=d) involved of such determination and the terms and effectiveness of such waiver.
    - (B) **Denial of waiver—** If the [Secretary](/usc/42/18024.md?p=c) determines a waiver should not be granted under [subsection (a)(1)](#a-1), the [Secretary](/usc/42/18024.md?p=c) shall notify the [State](/usc/42/18024.md?p=d) involved, and the appropriate committees of Congress of such determination and the reasons therefore.[^4]
- (e) **Term of waiver—** No waiver under this section may extend over a period of longer than 5 years unless the [State](/usc/42/18024.md?p=d) requests continuation of such waiver, and such request shall be deemed granted unless the [Secretary](/usc/42/18024.md?p=c), within 90 days after the date of its submission to the [Secretary](/usc/42/18024.md?p=c), either denies such request in writing or informs the [State](/usc/42/18024.md?p=d) in writing with respect to any additional information which is needed in order to make a final determination with respect to the request.

## Footnotes

[^1]: So in original. Probably should be “section”.
[^2]: See References in Text note below.
[^3]: So in original. Probably should be preceded by “the”.
[^4]: So in original. Probably should be “therefor.”

## Source credit

(Pub. L. 111–148, title I, § 1332, Mar. 23, 2010, 124 Stat. 203.)

## Notes

### Editorial Notes

### References in Text

Part I of subtitle E, referred to in subsec. (a)(3), is part I (§§ 1401–1415) of subtitle E of title I of Pub. L. 111–148, which enacted subchapter IV of this chapter and section 36B of Title 26, Internal Revenue Code, amended section 405 of this title, sections 280C, 6103, and 7213 of Title 26, and section 1324 of Title 31, Money and Finance, and enacted provisions set out as a note under section 36B of Title 26. For complete classification of part I to the Code, see Tables.

This title, where footnoted in subsecs. (a)(3) and (b)(1)(A) to (C), is title I of Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 130, which enacted this chapter and enacted, amended, and transferred numerous other sections and notes in the Code. For complete classification of title I to the Code, see Tables.

The Administrative Procedures Act, referred to in subsec. (a)(4)(B)(iii), probably means the Administrative Procedure Act, act June 11, 1946, ch. 324, 60 Stat. 237, which was classified to sections 1001 to 1011 of former title 5 and which was repealed and reenacted as subchapter II (§ 551 et seq.) of chapter 5, and chapter 7 (§ 701 et seq.), of Title 5, Government Organization and Employees, by Pub. L. 89–554, Sept. 6, 1966, 80 Stat. 378. See Short Title note preceding section 551 of Title 5.

The Social Security Act, referred to in subsec. (a)(5), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles XVIII, XIX, and XXI of the Act are classified generally to subchapters XVIII (§ 1395 et seq.), XIX (§ 1396 et seq.), and XXI (§ 1397aa et seq.), respectively, of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.

This Act, referred to in subsec. (b)(1)(A), is Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 119, known as the Patient Protection and Affordable Care Act. For complete classification of this Act to the Code, see Short Title note set out under section 18001 of this title and Tables.