State Exchange Profiles: Missouri


Final update made on December 13, 2012 (no further updates will be made) 

Establishing the Exchange

On November 6, 2012, Missouri voters passed a ballot measure blocking Governor Jay Nixon (D) from establishing an exchange via Executive Order.1 Legislation establishing a state-based health insurance exchange failed in both the 2012 and 2011 legislative sessions. While the Governor initially supported running a state-based exchange, he announced the state would default to a federal exchange in 2014.

Prior to the announcement, the Governor established Missouri’s Health Insurance Exchange Coordinating Council to coordinate the state’s response to federal health reform.2 The Council included executive leadership from multiple state agencies and established four work groups to address exchange components including, Operations; Finance and Coverage; Communications; and Cost-containment and Quality.3 The Council identified a number of consultants to provide background research and insurance market analysis to inform decision-making in the state. In June 2011, the Senate had also created the Senate Interim Committee on Health Insurance Exchanges to explore Missouri’s options to establish a state-based exchange.4

In August 2011, the Missouri Health Insurance Pool Board released a Request for Information for general exchange information technology component solutions and services; however the contract was never awarded.5 Missouri 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.6

In August 2010, Governor Nixon allowed a law prohibiting health insurance exchanges established in Missouri from offering insurance policies or riders that provide abortion coverage except in cases of life endangerment of the pregnant woman to become law without his signature (SB 793).7

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 Missouri has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Healthy Alliance (Blue Cross Blue Shield)- Blue Access Choice PPO.

Exchange Funding

In September 2010, the Missouri Department of Insurance received a federal Exchange Planning grant of $1 million. The Missouri Health Insurance Pool, a quasi-governmental, non-profit insurer that expanded to operate the federal high risk-pool in the state, received a $20.8 million federal Level One Establishment grant in August 2011, to build a coordinated information technology infrastructure with a single portal eligibility and enrollment system.However, the Senate Interim Committee, which has been critical of the state’s decision to apply for federal grant money without explicit approval from the legislature, has yet to approve spending the funds. In April 2012, the Missouri legislature rejected a $50 million federal grant to upgrade the state’s Medicaid information technology system because lawmakers saw it as a possible framework for building an exchange.9

Next Steps

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

1. Associated Press. “Nixon: Missouri won’t run health insurance exchange by 2014.” November 8, 2012. Kansas City Star.
2. The Health Insurance Exchange Coordinating Council was formerly the Health Care Cabinet
3. Missouri Level One Establishment Grant application:
4. Senate Interim Committee on Health Insurance Exchanges. (Accessed September 16, 2011)
5. Missouri Health Insurance Pool. Request for Information for Health Insurance Exchange Component Solutions and Services. RFI# 2011-001. August 19, 2011.
6. Enroll UX 2014 website.
7. Senate Bill 793. Modifies provisions relating to abortion. Delivered to Governor May 25, 2010.
8. “Creating a New Competitive Marketplace: Affordable Insurance Exchange Establishment Grant Awards List.” (Accessed August 18, 2011)
9. Nelson, J. “Bill gives Missouri voters say on health exchanges.” May 19, 2012. News-Leader.

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