State Innovation Waiver

Acronym: EDGE

Part of the ACA, a state can apply for a State Innovation Waiver) to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA. States can request that the federal government calculate issuers’ state RI payments based on the state RI parameters as part of the state’s section 1332 waiver plan. States would still be responsible for making reinsurance claims payments to issuers. CMS will only conduct the state’s RI calculations for the period outlined in the agreement with CMS on the applicable issuer’s EDGE server, and provide the information to the applicable state. The state is responsible for the Federal cost of this service, including development, implementation, maintenance, operations, and customer support. States are responsible for reimbursing CMS for these services.