State Exchange Profiles: Alabama

Final update made on December 4, 2012 (no further updates will be made)

Establishing the Exchange

Despite previously supporting Alabama’s implementation of a state-based health insurance exchange, Governor Robert Bentley (R) announced on November 13, 2012, the state will default to a federally-facilitated exchange.1

Prior to the decision, Governor Bentley issued Executive Order 17 which created the Alabama Health Insurance Exchange Study Commission to recommend how Alabama should establish a health insurance exchange.2 The Governor appointed an Executive Director of the Alabama Health Insurance Exchange to work with stakeholders and other state agencies on implementing the recommendations of the Commission.3After meeting for three months, the 15-member Health Insurance Exchange Study Commission released final recommendations in late November 2011 to the Governor and Legislature endorsing the establishment of the “Alabama Health Insurance Marketplace.”4 Additional recommendations included, establishing a new quasi-public authority to operate the exchange, following a free market facilitator model, establishing one administrative entity to oversee both the individual and small business exchanges while keeping the risk-pools for both separate, and funding the exchange through fees on all products sold in the individual and small group markets inside and outside the exchange.5

In May 2012, the Governor threatened to veto a bill establishing a state exchange, which passed in the House, if it cleared the Senate before the Supreme Court ruled on the constitutionality of the Affordable Care Act (ACA). The bill failed at the close of the 2012 legislative session, as did a similar bill in 2011.6

Governor Bentley signed into law a measure in May 2012, prohibiting health plans operating within an Alabama exchange from offering abortion services except in cases of life endangerment, rape, or incest.7

Information Technology (IT): In February 2012, the Office of the Alabama Health Insurance Exchange, within the Department of Insurance, released a Request for Information on the IT systems necessary to develop the state’s exchange.8 The state anticipated leveraging existing technology infrastructure to build components of the exchange related to screening, applications, and eligibility determinations. In June 2012, the Department released a Request for Proposals soliciting a subcontractor to build an eligibility and enrollment system capable of making determinations for the state’s Exchange, Medicaid, and the Children’s Health Insurance Program (CHIP); however, the award was put on hold until after the November elections.9 Alabama was also participating in the “Enroll UX 2014” project, which is a public-private partnership creating design standards for exchanges that all states can use.10

Alabama is focusing on a significant Medicaid eligibility system upgrade. The state received CMS approval for an enhanced federal match to assist in financing IT upgrades of the state’s Medicaid eligibility and enrollment system.11 The Alabama Medicaid Agency released a Request for Proposals earlier this year soliciting subcontractors to implement the new system which will meet future exchange interoperability standards.12 Work on the Medicaid eligibility system was anticipated to begin in April 2012.

Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Alabama has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield of Alabama 320 Plan PPO.

Exchange Funding

The Alabama Department of Insurance received a federal Exchange Planning grant of approximately $1 million in 2010. In November 2011, the Department was awarded an $8.6 million federal Level One Establishment grant to support contracts and activities around exchange implementation.13

Alabama, along with nine other states, received technical assistance from the Robert Wood Johnson Foundation through the State Health Reform Assistance Network; this assistance included help with setting up health insurance exchanges, expanding Medicaid to newly eligible populations, streamlining eligibility and enrollment systems, instituting insurance market reforms and using data to drive decisions.14

Next Steps

The federal government will assume full responsibility for running a health insurance exchange in Alabama beginning in 2014.

Additional information about Alabama’s health insurance exchange efforts can be found at:

1. Office of the Governor Press Release. Governor Bentley Announces Alabama will Not Set Up State Insurance Exchange. November 13, 2012.
2. Executive Order 17 issued on June 2, 2011.
3. Press Office Release Governor Bentley. “Alabama Health Insurance Exchange Study Commission Holds Organizational Meeting.” September 16, 2011.
4. Alabama Health Insurance Exchange Study Commission Recommendations. Alabama Department of Insurance. November 2011.
5. Alabama Exchange Planning Grant, Quarter 2 Report. (1/1/2011-3/31/2011)
6. King, Samuel. “Governor promises veto of insurance exchange bill.” May 12, 2012.
7. SB 10. 2012 Regular Session. Enrolled Copy.
8. Request for Information. Department of Insurance. Office of the Alabama Health Insurance Exchange. February 23, 2012.
9.Request for Proposal for the Alabama Health Insurance Exchange System. Department of Insurance- Office of the Alabama Health Insurance Exchange. June 7, 2012.
10. Enroll UX 2014 website.
11. Performing Under Pressure: Annual Findings of a 50-state survey of Eligibility, Enrollment, Renewal, and cost-sharing policies in Medicaid and CHIP. January 2012. Kaiser Family Foundation.
12. Request for Proposal for the Medicaid Eligibility Determination System. Alabama Medicaid Agency. January 5, 2012.
13. Creating a New Competitive Marketplace: Health Insurance Exchange Establishment Grants Awards List. December 1, 2011).
14. Robert Wood Johnson Foundation. ‘RWJF Seeks Coverage of 95 Percent of All Americans by 2020.’ May 6, 2011.

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