Notice of Annual Public Forum on June 17, 2026
Public Forum Recording Public Forum Transcript
Regarding Section 1332 State Innovation Waiver and Reinsurance Program
State of NH Final 1332 State Innovation Waiver Extension Application
Approval of Extension Application
In its 2019 session, the New Hampshire Legislature further amended Section 12 of RSA 404-G, effective July 1, 2019 (the 2019 Statutory Amendments) to permit the Insurance Commissioner, if supported by the recommendation of actuarial experts, to request that the Association propose a plan of operation for a risk sharing program, reinsurance program, or other program that will best support the availability and affordability of the individual insurance market in the state. Pursuant to the 2019 Statutory Amendments and based on the report of his actuarial experts, the Insurance Commissioner issued an order on February 25, 2020 requiring the Association to assess and develop, if in furtherance of the Association’s purpose, a proposal for a reinsurance program with the support of federal funding in the form of shared savings under a State Innovation Waiver (a/k/a State Relief and Empowerment Waiver) under Section 1332 of the Affordable Care Act (the Section 1332 Waiver).
In response to the Insurance Commissioner’s order, the Association, in consultation with experts and legal counsel and the Insurance Commissioner, reviewed the actuarial analysis and proposed a State market stabilization program in conjunction with a related Section 1332 Waiver application. To document its proposed program pursuant to Section 12 of the Statute, the Association adopted a Second Amendment to its Amended and Restated Plan of Operation (the Second Amendment) on March 11, 2020. During 2020, all of the conditions to the implementation of the proposed program, known as the New Hampshire Reinsurance Program (the Reinsurance Program), were met, including federal agency approval of the State’s Section 1332 Waiver application and its projected “pass-through savings.” On September 30, 2020, the Insurance Commissioner issued a Supplemental Order directing that the Association, as Administrator of the Reinsurance Program, receive the federal grant monies under the Section 1332 Waiver. The Association adopted a Third Amendment to its Amended and Restated Plan of Operation (the Third Amendment) on October 20, 2020, which allows and directs the Association to become the grantee of record under the Section 1332 Waiver, and to accept and receive directly federal funding under the Section 1332 Waiver.
The Reinsurance Program commenced operation on January 1, 2021, and has been administered by the Association on behalf of the New Hampshire Department of Insurance (the Insurance Department). The Reinsurance Program reimburses issuers who offer comprehensive, major medical plans in New Hampshire’s individual market that are part of the single-risk pool. Payments to carriers are calculated based on a percentage (coinsurance percentage) of the annual claims that issuers incur for coverage under such plans between a specified lower threshold (attachment point) and upper threshold (reinsurance cap). The reinsurance parameters are established annually by the Association’s Board of Directors and approved by the New Hampshire Insurance Department Commissioner by March 31 of the prior year. The Amended and Restated Plan of Operation, as further amended, requires that all funding collected for the Reinsurance Program be paid out (for payments to issuers and for program administration and reserves) for the year for which it is collected, but no additional State funds are provided for the Reinsurance Program. The Association’s obligation to make payments to issuers under the Reinsurance Program is limited to the extent of funding received by the Association in connection with the Reinsurance Program.
The Association began collecting quarterly assessments on behalf of the State of New Hampshire for the Reinsurance Program, as approved by the Commissioner, in 2021. The accounting rules adopted by the Association will treat the State based assessment collections (less administrative expenses) as deferred assessments until specific claims costs are identified or other operating costs are recorded.
In 2025, the Association drew the federal grant funds of $28,035,719 with $14,290,396 of State of NH Reinsurance Assessment proceeds, net of expenses distributed $42,326,115 in funds to the three participating carriers in the 2024 program. In 2024, the Association drew the federal grant funds of $32,044,848 with $12,573,565 of State of NH Reinsurance Assessment proceeds, net of expenses distributed $44,618,413 in funds to the three participating carriers in the 2023 program.
The Association received a Notice of Award of $34,066,714 for the 2025 program which funds will be drawn in 2026 to reimburse participating carriers for qualifying claims in 2025. The Association received a Notice of Award of $28,035,719 for the 2024 program which was drawn in 2025 to reimburse participating carriers for qualifying claims in 2024. The Association received a Notice of Award of $32,044,848 for the 2023 program which was drawn in June 2024 to reimburse participating carriers for qualifying claims in 2023.
The State of New Hampshire initially was granted a Section 1332 Waiver under the Affordable Care Act, with the Association designated as the grantee responsible for its administration. The Waiver had an expiration date of December 31, 2025. In 2024, the Association filed an application with, and received from, the Centers for Medicare & Medicaid Services (CMS) an extension of the Section 1332 Waiver, ensuring the continued operation of the Reinsurance Program through December 31, 2030 absent subsequent federal administrative or legislative changes.
In 2024, the Association consolidated all prior amendments to its Amended and Restated Plan of Operation and made additional amendments to conform to the revisions to RSA 404-G (which became effective January 1, 2024) by replacing its Amended and Restated Plan of Operation with a Second Amended and Restated Plan of Operation (sometimes referred to as the Second Restated Plan). The Second Restated Plan, as subsequently amended, governs the Association’s administration of each of its programs.