In this issue brief, Patricia Boozang, Deborah Bachrach and Hailey Davis of Manatt Health Solutions, review the coverage and delivery system challenges that Massachusetts could address through sections 1331 (the Basic Health Program) and 1332 (Waivers for State Innovation) of the Affordable Care Act (ACA). This brief describes the federal requirements related to these sections of the law and identifies the options the Commonwealth could pursue to advance its coverage, fiscal, and policy priorities, including: improving affordability and ease of access to coverage for low-income residents, continuing the expansion of insurance coverage to hard-to-reach populations, and evaluating and revisiting policy decisions like the individual mandate to determine the best fit for Massachusetts.