Exchanges

Pixmac000075666819Let us help you understand Exchanges and their role in your business strategy. As at the end of May 2013, there are 17 declared state-based exchanges and 7 more states are planning for partnership exchanges with the federal government. 27 states have indicated their default to Federal Exchange only.

All Exchanges must be up and running effective January 1, 2014 with enrollment commencing October 1, 2013. The following are State Decisions For Creating Health Insurance Exchanges, as of May 28, 2013.

For more information see http://kff.org/health-reform/state-indicator/health-insurance-exchanges/#map

Location

Exchange Decision

Federal Approval Status

Structure of Exchange

Type of Exchange

United States 17 Declared State-based Exchange; 7 Planning for Partnership Exchange; 27 Default to Federal Exchange NA NA NA
Washington Declared State-based Exchange Conditional approval Quasi-governmental Clearinghouse
Vermont Declared State-based Exchange Conditional approval Operated by State Active purchaser
Rhode Island Declared State-based Exchange Conditional approval Operated by State Active purchaser
Oregon Declared State-based Exchange Conditional approval Quasi-governmental Active purchaser
New York Declared State-based Exchange Conditional approval Operated by State Active purchaser
New Mexico Declared State-based Exchange4 Conditional approval Quasi-governmental Not yet addressed
Nevada Declared State-based Exchange Conditional approval Quasi-governmental Clearinghouse
Minnesota Declared State-based Exchange Conditional approval Quasi-governmental Clearinghouse
Massachusetts Declared State-based Exchange Conditional approval Quasi-governmental Active purchaser
Maryland Declared State-based Exchange Conditional approval Quasi-governmental Clearinghouse
Kentucky Declared State-based Exchange2 Conditional approval Operated by State Not yet addressed
Idaho Declared State-based Exchange1 Conditional approval Quasi-governmental Clearinghouse
Hawaii Declared State-based Exchange Conditional approval Non-profit Clearinghouse
District of Columbia Declared State-based Exchange Conditional approval Quasi-governmental Clearinghouse
Connecticut Declared State-based Exchange Conditional approval Quasi-governmental Clearinghouse
Colorado Declared State-based Exchange Conditional approval Quasi-governmental Clearinghouse
California Declared State-based Exchange Conditional approval Quasi-governmental Active purchaser
Wyoming Default to Federal Exchange NA NA NA
Wisconsin Default to Federal Exchange NA NA NA
Virginia Default to Federal Exchange2 NA NA NA
Utah Default to Federal Exchange5 NA NA NA
Texas Default to Federal Exchange NA NA NA
Tennessee Default to Federal Exchange NA NA NA
South Dakota Default to Federal Exchange2 NA NA NA
South Carolina Default to Federal Exchange NA NA NA
Pennsylvania Default to Federal Exchange NA NA NA
Oklahoma Default to Federal Exchange NA NA NA
Ohio Default to Federal Exchange2 NA NA NA
North Dakota Default to Federal Exchange NA NA NA
North Carolina Default to Federal Exchange NA NA NA
New Jersey Default to Federal Exchange NA NA NA
Nebraska Default to Federal Exchange2 NA NA NA
Montana Default to Federal Exchange2 NA NA NA
Missouri Default to Federal Exchange NA NA NA
Mississippi Default to Federal Exchange3 State-based blueprint rejected NA NA
Maine Default to Federal Exchange2 NA NA NA
Louisiana Default to Federal Exchange NA NA NA
Kansas Default to Federal Exchange NA NA NA
Indiana Default to Federal Exchange NA NA NA
Georgia Default to Federal Exchange NA NA NA
Florida Default to Federal Exchange NA NA NA
Arizona Default to Federal Exchange NA NA NA
Alaska Default to Federal Exchange NA NA NA
Alabama Default to Federal Exchange NA NA NA
West Virginia Planning for Partnership Exchange Conditional approval NA NA
New Hampshire Planning for Partnership Exchange Conditional approval NA NA
Michigan Planning for Partnership Exchange Conditional approval NA NA
Iowa Planning for Partnership Exchange Conditional approval NA NA
Illinois Planning for Partnership Exchange Conditional approval NA NA
Delaware Planning for Partnership Exchange Conditional approval NA NA
Arkansas Planning for Partnership Exchange Conditional approval NA NA

 

Footnotes

  1. Idaho received conditional approval from HHS to run a state-based exchange. However, due to time constraints in implementing an IT system, the Idaho Health Insurance Exchange Board voted to work with the federal government in running the individual and SHOP exchange until their IT platform is fully developed. The state will maintain plan management and consumer assistance functions, while the federal government will operate the IT system.
  2. Seven states, Kansas, Maine, Montana, Nebraska, Ohio, South Dakota, and Virginia have received approval from HHS to conduct plan management activities to support certification of qualified health plans in the federally-facilitated exchange.
  3. On November 14, 2012, Mississippi’s elected Commissioner of Insurance Mike Chaney submitted a blueprint application to HHS indicating the state’s intent to establish a Health Insurance Exchange. However, Governor Phil Bryant opposed the establishment of a state-based exchange and on February 7, 2013, HHS rejected the state’s application.
  4. New Mexico received conditional approval from HHS to run a state-based exchange. However, due to time constraints in implementing an IT system, the New Mexico Health Insurance Exchange Board voted to work with the federal government in running the individual exchange until October 2014. The state will maintain plan management and consumer assistance functions, while the federal government will operate the IT system. The state will run the SHOP exchange.
  5. On May 10, 2013, in a letter to Governor Governor Gary Herbert, HHS announced that it will operate a federally-facilitated individual exchange in Utah and will permit the state to operate the small business, or SHOP, exchange.