CMS rejects Ohio's individual mandate waiver

The CMS has rejected Ohio's request to become the first state to waive the Affordable Care Act individual mandate that requires residents to have health insurance.

Ohio's Legislature called for a 1332 innovation waiver last summer, before Congress zeroed out the financial penalty for not having coverage in its tax bill in December. But the waivers must follow provisions of the ACA that require the number of people covered remains the same and that their benefits remain comprehensive. The CMS said Ohio did not meet those requirements. State officials also never provided a reason why they should be exempt from the individual mandate.

"For this reason and those described above, the departments determined that the application is not complete," the CMS said.

Ohio Department of Insurance Director Jillian Froment said in a March 30 letter to HHS Secretary Alex Azar that the reason why the state was requesting the waiver was that "the (tax) legislation zeroed out the penalty that is associated with the individual mandate … but … did not eliminate the mandate itself."

Ohio officials now are determining potential next steps, according to Chris Brock, a spokesman for the state's department of insurance.

In its application to HHS, Ohio actuaries predicted individual market enrollment will fall from 307,000 people this year to 248,000 enrollees in 2022, and average monthly premiums will increase from $493 to $600 in the same time frame.

State officials and Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation, said that would happen as a result of the elimination of the tax penalty.