The Trump administration is soliciting new ideas to improve the 1332 waiver system that allows states to bypass parts of the Affordable Care Act, the latest move to get more states interested.
The request for information issued Wednesday comes after the CMS and Treasury Department in October relaxed the process for states to get a waiver, which were created under the ACA to enable states to provide alternative coverage approaches.
The agencies want to develop new waiver concepts beyond four concepts that it released late last year.
"Ultimately, the goal here is to see states develop new waiver concepts and submit waiver applications that improve their health insurance markets," CMS Administrator Seema Verma said in a blog post.
The October guidance gave states several moves to adopt 1332 waivers quickly. State legislatures no longer have to approve a waiver plan and governors can take unilateral action.
States can also apply for a waiver to divert income-based subsidies to lower the cost of ACA exchange plans to cheaper, short-term, limited duration plans, the guidance said.
But states can't use waivers on some ACA requirements, such as guaranteed coverage of pre-existing conditions.
Critics of the Trump administration and proponents of the ACA have said that the CMS and Treasury are promoting the waivers after Congress failed to repeal the healthcare law.
"With efforts to repeal or substantially alter the ACA completely off the table in Congress, waivers provide an opportunity for the Trump administration to shift the program in a more conservative direction state by state," said Larry Levitt, executive vice president of the not-for-profit Kaiser Family Foundation.
The CMS has approved eight 1332 waivers, with seven focusing on reinsurance programs.
"States so far haven't exactly rushed to take advantage of that new flexibility," Levitt said. "This new request for information may be a way to jumpstart the waiver process and get states engaged."