Insights

On Dec. 30, 2016, CMS approved part of Hawaii’s Section 1332 request for a waiver of SHOP requirements. The approval is in effect for five years- Jan. 1, 2017 through Dec. 31, 2021. As a result, the following provisions are waived in Hawaii:

• State/federal establishment of a SHOP
• Employee choice of QHPs at a single level of coverage through the SHOP
• Continuation of participation in the SHOP for growing employers
• CO-OPs and multi-state plans be recognized as QHPs in the SHOP

CMS denied Hawaii’s request for state agencies other than Medicaid to participate in the exchange. The individual exchange in Hawaii will continue to be operated as a federally-facilitated exchange through www.healthcare.gov.

CMS approved Hawaii’s waiver request based upon Hawaii’s unique Prepaid Health Care Act, which requires employers to provide certain coverage to employees working 20 hours or more per week. The employer must pay at least 50 percent of the premium and the employee’s contribution for self-only coverage cannot exceed one and a half percent of the employee’s wages. There is assistance available for employers who are experiencing bankruptcy or employers who have under eight employees and who may be having financial difficulty complying. The waiver is conditioned upon the continuance of these programs and ongoing reporting.

CMS Memorandum of Approval »