This week, our In Focus section reviews a checklist published on May 11, 2017, by the Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information & Insurance Oversight (CCIIO) providing states with a guide to applying for a Section 1332 State Innovation Waiver. The 1332 Waiver was authorized under Section 1332 of the Affordable Care Act (ACA) and allows states to “pursue innovative strategies for providing… access to high quality, affordable health coverage.” The checklist, as well as a March 13, 2017, letter to state governors from Health and Human Services (HHS) Secretary Tom Price and Secretary of the Treasury Steven Mnuchin, are specifically encouraging states to pursue approval of 1332 Waivers that include high-risk pool and state-operated reinsurance programs. The move comes in response to President Donald Trump’s Executive Order directing agencies to “alleviate the burdens of the ACA.” The checklist specifically notes that if state-operated reinsurance programs demonstrate a reduction in federal spending on premium tax credits, a state could receive federal pass-through funding to help fund the reinsurance program.