Final update made on September 29, 2013 (no further updates will be made)

Establishing the Marketplace

On April 12, 2006, former Governor Mitt Romney (R) signed into law comprehensive health reform legislation designed to provide near-universal health coverage for state residents.¹  The Massachusetts health reform law became the model for national health reform.

An important component of the law was the creation of the Massachusetts Health Connector, a health insurance marketplace that manages several coverage programs. Commonwealth Care provides subsidized coverage for individuals with incomes below 300% of the federal poverty level ($33,510 for an individual and $69,150 for a family of four in 2012) and Commonwealth Choice enables those who are not eligible for Commonwealth Care to shop for and purchase insurance offered by private health plans. In 2010, the Massachusetts Connector launched the Business Express program for businesses with 50 or fewer employees. As of August 2013, the Connector enrolled over 254,000 individuals in coverage—over 207,000 in Commonwealth Care and more than 42,000 in Commonwealth Choice, including approximately 5,000 enrollees in Business Express.²  Enrollment is expected to continue to increase in fiscal year 2013, in part due to reintegration of legal immigrants who became eligible for enrollment in the Connector after a recent Massachusetts Supreme Court decision.

In 2012, Governor Deval Patrick (D) enacted two laws affecting the Health Connector.^3 ,4  The first authorized the Health Connector to be certified as a state-based exchange as defined in the Affordable Care Act (ACA) and gave the Health Connector authority to perform key tasks, such as establishing a Navigator program and administering appeals related to the federal exchange. The second law included a number of provisions related to the ACA, including: designating the Connector as the entity to conduct risk adjustment; authorizing the Health Connector to sell stand-alone dental, vision, catastrophic, and child-only plans; and designating the Health and Human Services Department (known as MassHealth) to administer the Basic Health Plan option.

Structure: The Massachusetts Health Connector was established as a quasi-governmental organization, specifically a “public entity not subject to the supervision and control of any other executive office.”

Governance:  The Health Connector is governed by an 11-member Board, including four ex officio members (or designees): Secretary for Administration and Finance, Director of Medicaid, Commissioner of Insurance, and Executive Director of the Group Insurance Commission.  The Governor appoints an actuary, a health economist, a representative of small business, and an underwriter. The Attorney General appoints an employee health benefits specialist, a representative of health consumers, and a representative of organized labor. Appointees cannot be employed by an insurance carrier licensed in Massachusetts.

Current appointed Board members are:

• George Gosner Jr, Spring Insurance Group

• Jonathon Gruber, Massachusetts Institute of Technology

• Andrés López, AJL Consultants

• Louis Malzone, Massachusetts Coalition of Taft-Hardly Funds

• Nancy Turnbull, Harvard School of Public Health

• Celia Wcislo, 1199 SEIU United Healthcare Workers East
• Ian Duncan, Solucia Inc.

Contracting with Plans:  The Health Connector acts as an active purchaser and requires health insurance carriers offering plans through the Connector to receive the “Seal of Approval” by meeting requirements such as participation in all Commonwealth Choice offerings (meaning individual and small group) and offering all standardized benefit packages for all plan benefit levels (gold, silver, bronze, and young adult plans). Carriers may also offer non-standardized products to consumers, and the Health Connector is considering displaying these plans within the corresponding metal tiers (as suggested by an actuarial review).⁵  For 2013 plan year, the Connector received proposals from all eight existing Commonwealth Choice carriers and one new entrant, and granted the Seal of Approval to all standardized and non-standardized plans.

The Seal of Approval process provides the framework for the Health Connector’s certification, recertification, decertification, and ongoing performance monitoring processes. It is substantially in compliance with the Affordable Care Act’s (ACA) qualified health plan certification standards and only a few refinements are necessary.

On February 21, 2013, the Health Connector released the 2014 Seal of Approval Request for Responses (RFR). Participating insurers must offer seven standardized plans on their broadest commercial network, including two Platinum plans, three Gold plans, one Silver plan, and one Bronze plan. In addition, issuers with at least 1,000 members must offer a tiered-network Platinum or Gold plan. Issuers may also offer additional standardized plans with narrower networks and up to seven non-standardized plans. Issuers must also propose a Catastrophic plan and Wrap-Compatible Silver Plan, though not all of the proposed plans will be selected by the Health Connector.⁶ 

The Wrap-Compatible Silver Plans will be available to those with incomes up to 300% of the federal poverty level and will provide additional subsidies to lower premiums and cost-sharing so that the costs are in line with what individuals currently pay for coverage through the Commonwealth Care program. All Wrap-Compatible Silver Plans must meet the network adequacy standards that currently apply to Commonwealth Care.

On September 12, 2013, the Health Connector’s Board of Directors awarded the Seal of Approval for plans offered by ten health insurers and five dental carriers to be sold on the Health Connector for coverage beginning January 1, 2014. These insurers will offer 114 medical plan options and 24 dental plan options. Seven carriers will offer plans in the new ConnectorCare program.⁷ 

Dental and Vision Benefits: The Health Connector plans to include stand-alone dental plans beginning in 2014 and using a dental Seal of Approval program in parallel with the medical benefit. The Connector released the RFR for stand-alone dental plans on February 21, 2013. Stand-alone dental issuers are required to offer three standardized plans, including a pediatric plan, and a low and high cost adult plan. The adult plans will be sold to single adults as well as families. For families choosing one of the adult plans, any children will receive the scope of benefits and cost-sharing associated with the pediatric dental essential health benefit. In addition to the stand-alone dental plans, carriers may offer plans that integrate the medical and dental benefits or that bundle and price together a medical and dental plan.⁸ 

Risk Adjustment, Reinsurance, and Risk Corridors: Massachusetts will administer the Connector’s risk adjustment program. A multi-agency workgroup, co-chaired by the Connector and Division of Insurance, is developing the methodology and plans to leverage the state’s existing All-Payer Claims Database.⁹  In June 2013, the Health Connector, in collaboration with the Center for Health Information Analytics conducted comprehensive risk adjustment simulation and completed data quality assessments for all carriers. The Division of Insurance will also oversee administration of the transitional reinsurance program.

Consumer Assistance and Outreach: The Health Connector has developed a multi-faceted outreach and marketing campaign. The Outbound Calling campaign will target 215,000 current and newly eligible Health Connector members transitioning to new coverage. Calls will be made by the customer service vendor and will enable consumers to apply over the phone. There will also be a direct mail and an e-mail campaign to run from August 2013 through March 2014 that will include important messages, as well as notifications and reminders. The Health Connector also launched a Public Information Unit to respond to questions from the public and legislators.  The unit identifies recurring issues that will inform other outreach activities, including Navigator training, road shows, etc.¹⁰  The Health Connector will also conduct “Road Shows” targeting small employers and is partnering with Health Care for All to conduct a grassroots, public education campaign.

Over the summer, the Health Connector did a soft-launch of the new branding campaign, including the new logo and website, and in September 2013, the new Contact Center was launched. In addition, two walk-in centers to provide in-person support will be available. Paid and earned media campaigns will launch in the fall while the Health Connector re-launched its social media presence on Twitter, Facebook, and Google+ in August.

On July 22, 2013, the Health Connector announced the ten organizations selected to serve as Navigators. These organizations will target the remaining uninsured and will focus on populations transitioning from existing programs to new coverage available beginning in January 2014.¹¹  Navigators must complete required training programs and be certified before they can begin assisting consumers. Initial training of Navigators began in August 2013 and continued through September. A third phase of training is anticipated in November/December in support of additional system functionality. Navigators must also attend quarterly policy and operation check-in meetings.

In addition to Navigators, the Health Connector is leveraging MassHealth’s existing Virtual Gateway program and its network of 200 hospitals and health centers to serve as Certified Application Counselors. It has also provided regional training to brokers

Small Business Health Options Program (SHOP) Marketplace: The Division of Insurance has identified a subcontractor to evaluate the impact on the insurance market of broadening the definition of small employer to those with 100 or fewer employees before 2016.¹²  The Health Connector currently offers the Business Express program, which allows small employers to select a Connector plan to offer to their employees. As the Health Connector converts its Business Express program to the SHOP, the Connector will offer small employers three plan selection options: selection of single plan offered by a single insurer; selection of all plans offered at a particular metal tier; or selection of multiple metal tier plans offered by a single insurer. All QHPs, including both standardized and non-standardized plans, except for catastrophic plans will be available to small employers.

The Health Connector is creating “Sub-connectors,” an alternative distribution channel for small employers (and the brokers who serve them) to purchase coverage through the Health Connector while retaining aspects of their current shopping experience. The goal is to allow more small businesses to access QHPs through the Connector.¹³  The Health Connector has issued a Request for Information (RFI) to collect feedback on licensing requirements for Sub-connectors.

The Connector hopes to leverage knowledge acquired from the Contributory Plan pilot, which was frozen shortly before the Business Express was introduced in 2010. The Contributory Plan allowed employers to fix their contribution to premium costs, while still providing meaningful plan choice to employees. Previous experience with the Contributory Plan indicated that the concept appealed to employers but there were opportunities for improvement to make the methodology consistent across carriers and ensure the shopping experience was simple and intuitive.

Basic Health Program (BHP): In June 2012, MassHealth was authorized to create a BHP.¹⁴   The BHP is an optional coverage program available through the ACA that allows states to use federal funding to offer subsidized health insurance to adults with incomes between 139% and 200% of the federal poverty level (FPL) who would otherwise be eligible to purchase subsidized coverage through an Exchange. In addition, the Connector was authorized to make wrap-around premium and cost-sharing subsidies available to individuals covered by qualified health plans through the Health Connector if their incomes were between 200% and 300% FPL. The wrap-around subsidy was meant to hold the new premiums for individuals with incomes up to 300% of FPL in line with the current premiums for Commonwealth Care.

However, HHS delayed issuing regulations for the BHP forcing the state to consider an alternative approach. given the delay in federal guidance detailing the administration of a BHP, Massachusetts developed an alternative approach. The QHP Wrap program provides state-based wrap-around subsidies for individuals with incomes between 139% and 300% FPL who are enrolled in specified QHPs.¹⁵  Only carriers that offer the lowest-priced QHPs will be qualified to offer the wrap plans. The state submitted an amendment to its Medicaid Section 1115 demonstration waiver to obtain federal funding to support the state wrap-around subsidies.

Essential Health Benefits (EHB): The Affordable Care Act requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Marketplace, cover certain defined health benefits. Along with collecting stakeholder feedback, the Division of Insurance compared the ten possible EHB benchmark plans and concluded that the three largest small group plans offered in Massachusetts offer similar benefits and have virtually the same relative value.¹⁶  Massachusetts selected Blue Cross Blue Shield’s HMO Blue, the largest small group plan, as the EHB benchmark.¹⁷   The DOI also recommended that the benchmark plan be supplemented with the state’s CHIP pediatric dental benefit plan.

Financing: Massachusetts initially appropriated $25 million to operate the Health Connector, but it is now financially self-sustaining and authorized to apply a surcharge to all health benefit plans offered through the Connector. The collected funds pay for the Health Connector’s administrative and operational expenses, not premium assistance payments, under Commonwealth Care.

The Health Connector is developing a long-term financing strategy that involves continued state funding and a carrier administrative fee targeted at or below 2.5% of premium. Because of the availability of federal Establishment Grant funding to support Health Connector operations in 2014, the carrier administrative fee for 2014 has been temporarily eliminated.¹⁸ 

Marketplace Funding

In September 2010, the Massachusetts Commonwealth Insurance Connector Authority received a federal Exchange Planning grant of $1 million. In February 2012, the Connector Authority also received a Level One Establishment grant of $11.6 million to analyze coverage transitions and the operational interface between the Exchange and the state’s Medicaid program.¹⁹   In addition, Massachusetts is a member of the consortium of New England States Collaborative Insurance Exchange Systems that received a federal Early Innovator grant of $36 million to develop, share, and leverage insurance exchange technology.²⁰  The University of Massachusetts Medical School is the grant holder.  In September 2012, Massachusetts received a second Level One grant of $41.7 million dollars to create a risk-adjustment program and support IT development lead by the HIX/IES. In January 2013, the Connector received a Level Two grant of $81.3 million to support creation of a state-specific risk adjustment program, development of an outreach and education campaign, and the first year of operations of the Connector as an ACA-compliant exchange.²¹ 

Next Steps

On December 7, 2012, Massachusetts received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a State-based Marketplace.²²   Until new coverage begins on January 1, 2014, the state will continue providing coverage to eligible individuals through existing programs, including Commonwealth Care and Commonwealth Choice. Beginning October 1^st, the state will start to transition consumers to their new coverage options.

Additional information about the Massachusetts Connector can be found at:  https://www.mahealthconnector.org/ and http://bettermahealthconnector.org/

1. Chapter 58. An Act Providing Access to Affordable, Quality, Accountable Health Care. April 12, 2006. Part I, Chapter 176Q. Administration of the Government, Commonwealth Health Insurance Connector.  ↩︎
2. Massachusetts Connector Quarterly Program Summary Report, August 2013. September 6, 2013.  ↩︎
3. Chapter 96. An Act Making Appropriations for the Fiscal Year 2012 to Provide for Supplementing Certain Existing Appropriations and For Certain Other Activities and Projects.  ↩︎
4. Chapter 118. An Act Making Appropriations for the Fiscal Year 2012 to Provide for Supplementing Certain Existing Appropriations and For Certain other Activities and Projects.  ↩︎
5. Stephany S and Yang J. “Commonwealth Choice 2013 Seal of Approval.” Presented to the Health Connector Board of Directors. September 13, 2012.  ↩︎
6. The Health Connector Team “2014 Seal of Approval Launch” presented to the Health Connector Board of Directors, February 14, 2013.  ↩︎
7. The Health Connector press release, “Health Connector Announces Seal of Approval for Health Insurance Plans Effective January 2014” September 12, 2013.  ↩︎
8. “2014 Seal of Approval Launch” presentation. ↩︎
9. Apicella D and Berardi C. “National Health Care Reform Update” Presented to the Health Connector Board of Directors, September 13, 2012.  ↩︎
10. “Outreach and Communications Strategy and Contract Extension” presentation to the Board of Directors, June 13, 2013.  ↩︎
11. Health Connector Announces Awardees of Massachusetts Navigator Grant Program, July 22, 103.  ↩︎
12. Massachusetts Executive Office of Health and Human Services. “Health Insurance Reform Working Group: ACA Changes to Small Employer Definition and Rating Factor Rules.” March 23, 2012.  ↩︎
13. Mansur R. “Licensing Procedures Request for Information.” November 16, 2012.  ↩︎
14. Chapter 118.  An Act Making Appropriations for the Fiscal Year 2012 to Provide for Supplementing Certain Existing Appropriations and For Certain other Activities and Projects. ↩︎
15. Yang J and Hague A. “2014 Seal of Approval Introduction (III): Subsidized Health Insurance and the QHP Wrap.” December 13, 2012.  ↩︎
16. Executive Office of Health and Human Services. “Analysis of Three Largest Small Group Plans for EHB Benchmark.” September 19, 2012.  ↩︎
17. Essential Health Benefits, Benchmark Plan for Massachusetts. Accessed January 8, 2013.  ↩︎
18. Board of the Commonwealth Health Insurance Connector Authority meeting minutes, February 14, 2013.  ↩︎
19. Massachusetts Health Insurance Connector Authority application for Level One Establishment grant. Project Abstract. December 27, 2011.  ↩︎
20. Massachusetts application for the Cooperative Agreement to Support Innovative Exchange Information Technology Systems. IE-HBE-11-001. The New England States Collaborative Insurance Exchange Systems (NESCIES)  ↩︎
21. Massachusetts Affordable Insurance Exchange Grants Awards List. ↩︎
22. Letter from Secretary Sebelius to Governor Patrick. December 7, 2012. ↩︎

Final update made on December 19, 2013 (no further updates will be made)

Establishing the Exchange

On November 15, 2012, Governor Dave Heineman (R) announced that Nebraska would not establish a health insurance exchange.¹Earlier in 2012, the Nebraska legislature introduced two bills (LB 835 and LB 838) to establish a health insurance exchange in Nebraska, however both failed when the legislative session concluded in April.^2,3

In 2011, Governor Heineman signed LB 22 into law, which prohibits qualified health insurance plans participating in health insurance exchanges from covering abortions in Nebraska, except when a physician has verified the abortion is necessary to prevent the pregnant woman’s death.⁴

Prior to Governor Heineman’s announcement, the Department of Insurance (DOI) had explored the possibility of a state-based exchange and released reports summarizing the results of early stakeholder interviews, examining policy options, and analyzing state demographics and the insurance market.⁵ In addition, the DOI had identified a subcontractor to assist with the planning and design of an exchange, including developing an exchange funding grant application, participating in user group discussions, and developing a cost allocation methodology among state agencies.⁶

In mid-2012, the DOI described policy assumptions developed through the planning process. Specifically, the assumptions were that Nebraska would have a single state-based exchange, operated within the DOI, which would serve both the individual and small employer markets, though with separate risk pools for the two markets.⁷ In addition, the exchange would not limit the number of qualified health plans (QHPs). In August and September of 2012, the Governor and DOI held a series of stakeholder meetings and public education sessions to collect public input related to planning an exchange.⁸

Contracting with Plans: On February 20, 2013, Director of Insurance Bruce Ramge sent a letter to the Center for Consumer Information and Insurance Oversight (CCIIO) requesting to maintain control over plan management functions despite not having entered into a state-federal partnership exchange. The Nebraska Department of Insurance (DOI) has the legal authority and operational capacity to oversee certification of Qualified Health Plans (QHPs). DOI will collect and analyze information on plan rates, covered benefits, and cost-sharing requirements. DOI will also ensure continued plan compliance, manage consumer complaints, and oversee decertification of issuers.⁹

On March 21, 2013, the state’s Department of Insurance issued a bulletin that spells out the requirements for qualified health plans seeking to sell coverage through the exchange.¹⁰ According to the bulletin, insurers must submit their applications by April 30^th and plans will be approved by July 31, 2013.

Consumer Assistance and Outreach: The DOI had made development of a marketing and outreach strategy a key next step in the planning process. In addition, the DOI described an approach to the Navigator program and the roles of agents and brokers.¹¹

In addition, Nebraska had planned to establish a call center in the state to respond to inquiries from consumers, Navigators/Assisters, and agents/brokers.¹² The call center would have been dedicated to the individual and small business health options program (SHOP) exchanges only, and any questions regarding Medicaid and the Children’s Health Insurance Program (CHIP) transferred to the existing call center in the Nebraska Department of Health and Human Services.

Information Technology (IT): In 2011, the DOI coordinated with the Nebraska Department of Health and Human Services to review the state’s current IT capabilities and operational procedures.¹³ That same year, the DOI used a Request for Proposals (RFP) to procure subcontractor assistance with the early stages of development, design, and creation of an enrollment, verification, and eligibility IT system for an exchange.¹⁴ In March 2012, the DOI released a Request for Information (RFI) for assistance with a cost analysis of current third-party IT platforms and turn-key solutions, components, and services that would be interoperable with existing federal and state systems.¹⁵

In September 2012, the state released an RFP for subcontractor assistance with development of multiple components of an exchange’s IT system, including a consumer portal, the enrollment and eligibility system, a case management system, and the business rules engine.¹⁶ The contract would have been awarded for a minimum of five years and include both development and maintenance services, though state IT or exchange staff were expect to operate and managed the systems once operational.

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. Based on a subcontractor analysis, actuarial study, and stakeholder insight, the DOI planned to recommend to the Governor that the state’s EHB benchmark plan be Nebraska’s current largest small group plan, Blue Cross Blue Shield of Nebraska- Blue Pride.¹⁷ On October 1, 2012, Governor Heineman selected a “Nebraska Option” for the state’s EHB plan.¹⁸ However, the plan was not approved by the federal Department of Health and Human Services and the state’s benchmark EHB plan defaulted to Blue Cross Blue Shield of Nebraska- Blue Pride PPO.

Exchange Funding

The Nebraska Department of Insurance received a federal Exchange Planning grant of $1 million in 2010. In November 2011, the Department of Insurance was also awarded a $5.5 million federal Level One Establishment grant to further plan and design an exchange for the state.¹⁹

Next Steps

On March 8, 2013, Nebraska received approval from CCIIO to perform plan management activities. The federal government will retain control over all other Exchange functions.²⁰

1. Governor Dave Heineman’s Remarks, November 15, 2012.http://www.governor.nebraska.gov/news/2012/11/pdf/Federal_Health_Insurance_Exchange.pdf2. LB 835. Nebraska’s 2012 Health Benefits Exchange Act.http://nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB835.pdf3. LB 838. Nebraska’s 2012 Health Benefit Exchange Act.http://nebraskalegislature.gov/FloorDocs/Current/PDF/Intro/LB838.pdf4. LB 22. Nebraska’s Mandate Opt-Out and Insurance Coverage Clarification Act of 2011.http://nebraskalegislature.gov/FloorDocs/Current/PDF/Slip/LB22.pdf5. “Health Insurance Exchange Planning Overview and Recommendations.” Nebraska Department of Insurance. October 2011. http://www.doi.ne.gov/healthcarereform/exchange/Health_Insurance_Exchange_Planning.pdf6. Nebraska Department of Insurance RFP 12-002Z1, Selection a qualified contractor to provide continued planning and design of the potential exchange. March 12, 2012 http://www.doi.ne.gov/rfp/RFP_12-002Z1/RFP_12-002Z1.pdf7. Presentation by the Nebraska Department of Insurance. “State of Nebraska’s Health Insurance Exchange: A Presentation to the Public.” September 2012.http://www.statereforum.org/sites/default/files/nebraska_public_meetings_9-14-12.pdf8. Press release from the office of Governor Heineman. “Gov. Heineman Announces Informal Public Meetings to Discuss Health Insurance Exchanges.” August 15, 2012.http://www.governor.nebraska.gov/news/2012/08/15_health_ins.html9. Letter from Director Ramge to Gary Cohen. February 20, 2013. http://cciio.cms.gov/Archive/Technical-Implementation-Letters/ne-exchange-letter-2-20-2013.pdf10. Nebraska Department of Insurance, “Filing Individual and Small Employer Health and Dental Plans in Nebraska,” March 21, 2013. http://www.doi.nebraska.gov/bulletin/cb130.pdf11. Presentation by the Nebraska Department of Insurance. “State of Nebraska’s Health Insurance Exchange: A Presentation to the Public.” September 2012.12. Nebraska Request for Proposal. RFP #4119Z1. September 14, 2012.http://www.das.state.ne.us/materiel/purchasing/RFP4119.pdf13. Nebraska: Healthcare Exchange Planning. Grant #1 HBEIE100048-0101. Reporting Quarter 07/01/2011-09/30/2011. http://www.doi.ne.gov/healthcarereform/exchange/quarterly_reports/2011.09.30.pdf14. Nebraska Department of Insurance RFP 11-001Z1, Exchange Planning Information Technology (IT) Consulting Services. March 7, 2011. http://www.doi.ne.gov/rfp/11-001Z1/RFP_11-001Z1.pdf15. Nebraska Department of Insurance RFP 12-001Z1, HIX Information Technology Solution. March 7, 2011http://www.doi.ne.gov/rfp/RFI_12-001Z1/RFI_12-001Z1.pdf16. Nebraska Request for Proposal. RFP #4119Z1. September 14, 2012.17. Nebraska Department of Insurance. “Presentation to the Banking, Commerce, and Insurance Committee.” September 14, 2012. http://www.statereforum.org/sites/default/files/nebraska_unicameral_9-14-12.pdf18. Press release. “Governor Heineman Submits ‘Nebraska Option’ for Obamacare Deadline.” October 1, 2012.http://www.governor.nebraska.gov/news/2012/10/01_ne_option.html19. Centers for Medicare & Medicaid Services. “Creating a New Competitive Marketplace: Health Insurance Exchange Establishment Grants Awards List.”http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html  (Accessed November 29, 2011).20. Letter from Gary Cohen to Director Ramge. March 8, 2013. http://cciio.cms.gov/Archive/Technical-Implementation-Letters/ne-pm-letter-3-8-2013.pdf

Final update made on April 19, 2013 (no further updates will be made)

Establishing the Exchange

In December 2012, Montana’s elected State Auditor Monica Lindeen (D) confirmed that the federal government would operate a health insurance exchange in Montana.¹ The previous year, two proposed bills (HB620 and HB124) to establish a health insurance exchange in Montana failed.^2,3 Instead, the legislature passed SB 228, a bill that would prohibit the creation of a health insurance exchange as proscribed in the Affordable Care Act of 2010. Governor Brian Schweitzer (D) vetoed SB 228 on April 13, 2011.⁴ Later in April, the legislature issued HJR 33, a joint resolution to allow the Economic Affairs Interim Committee to study the implications, options, and repercussions of a state-based health insurance exchange.⁵

Also in April 2011, the Governor vetoed SB 176, which would have prohibited qualified health plans participating in a health insurance exchange in Montana from covering abortions, except in cases of life endangerment or severe health impairment of the pregnant woman.⁶

Contracting with Plans: On February 26, 2013, Commissioner Lindeen sent a letter to the Center for Consumer Information and Insurance Oversight (CCIIO) requesting to maintain control over plan management functions despite not having entered into a state-federal partnership exchange. The Office of the Commissioner of Securities and Insurance (CSI) has the legal authority and operational capacity to oversee certification of Qualified Health Plans (QHPs). CSI will collect and analyze information on plan rates, covered benefits, and cost-sharing requirements. CSI will also ensure continued plan compliance, manage consumer complaints, and oversee decertification of issuers.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 Montana 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 Montana- Blue Dimensions.

Exchange Funding

The Montana State Auditor received a federal Exchange Planning grant of $1 million in 2010.

Next Steps

On March 8, 2013, Montana received approval from CCIIO to perform plan management activities. The federal government will retain control over all other Exchange functions.⁸

1. Dennison, M. “Lindeen: Feds Will Have Health Insurance Exchange Up Next Year.” Billings Gazette. December 10, 2012. http://billingsgazette.com/news/state-and-regional/montana/lindeen-feds-will-have-health-insurance-exchange-up-next-year/article_bc8af918-c068-5d0b-a62c-78879352a66a.html2. HB 620. Montana bill to generally revise health care law to create health care gateway. 2011.http://data.opi.mt.gov/bills/2011/billpdf/HB0620.pdf3. HB 124. Montana bill to create a state-level health insurance exchange. 2011.http://data.opi.mt.gov/bills/2011/billpdf/HB0124.pdf4. SB 228. Montana act prohibiting creation of a state-based health insurance exchange under the Patient Protection and Affordable Care Act. 2011. http://data.opi.mt.gov/bills/2011/billpdf/SB0228.pdf5. HJ 33. Montana’s joint resolution for an interim study of a health insurance exchange.http://data.opi.mt.gov/bills/2011/billpdf/HJ0033.pdf6. SB176. Montana’s 2011 act to prohibit plans in the exchange from covering abortion.http://data.opi.mt.gov/bills/2011/billpdf/SB0176.pdf7. Letter from Commissioner Lindeen to Gary Cohen. February 26, 2013. http://cciio.cms.gov/Archive/Technical-Implementation-Letters/mt-exchange-letter-2-26-2013.pdf8. Letter from Gary Cohen to Commissioner Lindeen. March 8. 2013. http://cciio.cms.gov/Archive/Technical-Implementation-Letters/mt-pm-letter-3-8-2013.pdf

Final update made on November 26, 2013 (no further updates will be made)

Establishing the Marketplace

While Governor Rick Snyder (R) supports the creation of a State-based Marketplace, he acknowledged on November 16, 2012, that without authorizing legislation, he would plan for a State-federal Partnership Marketplace.¹  The state began moving in the direction of a partnership in August 2012 due to legislative opposition that left the state unable to meet the federal timetable for implementation.²  Michigan will perform plan management functions and defer other Marketplace management functionality to the federal government.³ 

Contracting with Plans: The Department of Insurance and Financial Services (DIFS) performs plan management functions for health insurance products offered through the Marketplace, as well as plans sold outside the Marketplace. Eleven carriers are certified to participate in the Michigan Marketplace; ten offer Qualified Health Plans (QHPS) in the Individual Marketplace and eight offer small group coverage. Insurers may rate by age, tobacco use, and geography. There are 16 geographic rating areas in the state.⁴  Plans are offered on the Platinum, Gold, Silver, and Bronze metal level tiers, and catastrophic plans are available to those who are eligible. A tool that estimates premiums in Michigan’s individual Marketplace is available on the DIFS website. Information on plans and rates available to individuals and small businesses can be found on HealthCare.gov.

Dental and Vision Benefits: Dental coverage may be embedded in a QHP or offered as a stand-alone product. Eight dental carriers offer a total of 108 stand-alone dental plans through the Marketplace for 2014.⁵  Information on dental plans for individuals and small businesses is available on HealthCare.gov.

Consumer Assistance and Outreach: Since Michigan is not engaging in a consumer assistance partnership, the state does not operate an In-Person Assister (IPA) program and relies on the federally-run Navigator program to provide in-person assistance. In August 2013, the Department of Health and Human Services (HHS) selected four organizations in Michigan to serve as Navigators and awarded the grantees a total of over $2.5 million to perform education activities and enrollment assistance for individuals and small businesses. One Navigator organization will provide in-person services on a state-wide basis while the others will focus on smaller county-based service areas.⁶  All individual Navigators must complete an online training module and pass a test designed and administered by HHS. A bill (HB 4576) that would impose state licensing and certification requirements on Navigators is currently pending.⁷  In July 2013, 31 community health centers in Michigan received a total of $3.8 million in funding from the Health and Resources Services Administration (HRSA) to hire 69 additional workers to facilitate enrollment.⁸  Other organizations interested in assisting consumers applying for Marketplace coverage may apply to become volunteer Certified Application Counselors (CACs). Licensed agents and brokers that register and complete a federal training course may sell health insurance coverage through the Marketplace. The DIFS website provides further details about how consumers may locate and contact a Navigator, CAC, or agent for in-person assistance.

The DIFS is hosting a series of community events across the state to educate consumers on the implications of the Affordable Care Act. The DIFS has also produced a set of brochures explaining how the law impacts various populations, such as young adults, families, and small businesses.⁹ 

Small Business Health Options Program (SHOP) Marketplace: Issuers must maintain separate risk pools for the small group and individual Marketplaces. Employers with up to 50 employees are eligible to participate on the SHOP in 2014 and 2015.¹⁰  Employers must select a single QHP to offer employees in 2014; employers will have the option to offer their employees a choice of QHPs in 2015. 70% of employees eligible for health coverage must enroll in the SHOP in order for the employer to participate.¹¹ 

Essential Health Benefits (EHB): The ACA requires that all individual and small-group plans sold in a state, including those offered through the Marketplace, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. In September 2012, Governor Snyder informed HHS that Priority Health’s HMO plan had been selected as the state’s benchmark EHB plan for plan years 2014 and 2015. The MIChild dental program serves as the pediatric dental supplement, and the FEDVIP Blue Vision High plan is the pediatric vision supplement.¹²  Actuarial equivalent substitutions of benefits are not allowed in Michigan.¹³ 

Marketplace Funding

Michigan’s Department of Community Health was awarded a federal Exchange Planning grant of $1 million. In November 2011, Michigan’s Department of Licensing and Regulatory Affairs was awarded a $9.8 million federal Level One Establishment grant to conduct further insurance market analysis and technology planning; however, the Legislature has yet to approve spending the funds. In January 2013, Michigan received a second Level One grant of $30.7 million to support creation of a consumer assistance partnership program, establishment of an IT system that coordinates with federal partners, and the plan management functions that Michigan will carry out. However, the Senate failed to vote on HB 4111, which would authorize the state to spend the funds.¹⁴ 

Michigan, along with nine other states, is receiving technical assistance from the Robert Wood Johnson Foundation through the State Health Reform Assistance Network; this assistance includes help with setting up health insurance Marketplaces, expanding Medicaid to newly eligible populations, streamlining eligibility and enrollment systems, instituting insurance market reforms and using data to drive decisions.¹⁵ 

Next Steps

On March 5, 2013, Michigan received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a State-federal Partnership Marketplace.¹⁶  Enrollment into Marketplace coverage began on October 1, 2013. The federal government is operating the online eligibility and enrollment system, and consumers must use the federal portal to apply for coverage online.

1. Governor Snyder. “Michigan moves toward state-federal partnership health exchange, leaves door open for MI Health Marketplace.” November 16, 2012.  ↩︎
2. A Special Message from Governor Rick Snyder: Health and Wellness. Office of the Governor. September 14, 2011.  ↩︎
3. Letter from Governor Snyder to Secretary Sebelius. January 22, 2013. ↩︎
4. State of Michigan Department of Insurance and Financial Services. Bulletin 2013-07-INS.  ↩︎
5. State of Michigan Department of Insurance and Financial Services. Dental Plans. ↩︎
6. Navigator Grant Recipients. Centers for Medicare and Medicaid Services. August 2013. ↩︎
7. Michigan Legislature. House Bill 4576. 2013.  ↩︎
8. Michigan: Health Center Outreach & Enrollment Assistance. HRSA. July 2013.  ↩︎
9. Department of Insurance and Financial Services. Health Coverage Consumer Brochures.  ↩︎
10. State of Michigan Department of Insurance and Financial Services. Bulletin 2013-07-INS.  ↩︎
11. Department of Insurance and Financial Services. Essential Health Benefits and Plan Management FAQs. ↩︎
12. Letter from Governor Snyder to Secretary Sebelius. September 28, 2012. ↩︎
13. Department of Insurance and Financial Services. Essential Health Benefits and Plan Management FAQs. ↩︎
14. Michigan Affordable Insurance Exchange Grants Awards List.  ↩︎
15. Robert Wood Johnson Foundation. ‘RWJF Seeks Coverage of 95 Percent of All Americans by 2020.’ May 6, 2011.   ↩︎
16. Letter from Secretary Sebelius to Governor Snyder. March 5, 2013. ↩︎

Final update made on December 10, 2012 (no further updates will be made)

Establishing the Exchange

On December 10, 2012, Governor Bill Haslam (R) announced Tennessee would default to a federally-facilitated health insurance exchange.¹

Prior to the announcement that the state would not operate its own exchange, the Tennessee Department of Finance and Administration established the Insurance Exchange Planning Initiative to advise the Governor and Legislature on exchange implementation. The Initiative worked closely with a variety of stakeholders and content experts, including agents, brokers, underwriters, actuaries, providers, and advocates.^2,3 Stakeholder feedback was compiled into a white paper released in October 2011; findings indicated overwhelming preference for a state-run, rather than a federally-operated, exchange.⁴

A measure restricting health plans in the exchange from offering abortion coverage, with no exceptions, became law on May 5, 2010, without former Governor Phil Bredesen’s (D) signature (HB 2681/SB 2686).⁵Contracting with Plans: In September 2012, the Exchange Planning Initiative released a Request for Information for qualified health plans in the individual exchange market.⁶ In 2012, the state convened a new Technical Assistance Group (TAG) of actuaries to provide expertise on reinsurance and risk adjustment.⁷

Small Business Health Options Program (SHOP) Exchange: In March 2012, the state released a Request for Information on information technology services for the Small Employer Health Options Program exchange.⁸ The Department of Finance and Administration had solicited subcontractors to conduct multiple analyses related to the establishment of an exchange, including an analysis of the merger of the individual and small group markets.⁹

Information Technology (IT): The state released a Request for Proposals (RFP) soliciting subcontractors to implement a significant Medicaid eligibility system upgrade to seamlessly integrate with the Children’s Health Insurance Program (CHIP) and interface with an exchange. Tennessee also participated in the “Enroll UX 2014” project, which is a public-private partnership creating design standards for exchanges that all states can use.¹⁰

Tennessee Bridge Option: Tennessee developed the Bridge Option proposal as is an alternative to the Affordable Care Act’s (ACA) Basic Health Program.¹¹ Both options aim to improve the affordability of coverage for individuals with incomes above the Medicaid eligibility threshold and up to 200% of the poverty level. The Bridge Option would enable individuals moving from Medicaid to subsidized coverage in the Exchange to remain in lower-cost Medicaid managed care plans, or bridge plans. This approach would also allow all members of a nuclear family to hold coverage through a common insurer and provider network regardless of their eligibility status. The Department of Health and Human Services has indicated that states will be allowed to offer bridge plans through their exchanges, though it is not clear whether these plans will be offered in the federal exchange.

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 Tennessee 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 Tennessee PPO.

Exchange Funding

The Tennessee State Department of Finance and Administration received a $1 million federal Exchange Planning grant in September 2010. The Department has since received three federal Level One Establishment grants: $1.5 million in November 2011, $2.2 million in February 2012, and $4.3 million in May 2012. The grants are for continued exchange planning including for the procurement of technical expertise, funding staffing needs, planning for a health plan management system, marketing and outreach, and consumer assistance.¹²

Next Steps

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

Additional planning documents for Tennessee’s health insurance exchange can be found at:http://www.tn.gov/nationalhealthreform/exchange.html

1. ‘Haslam Announces State Will Not Run Health-Care Exchange.’ December 10, 2012.https://news.tn.gov/node/100172. Insurance Exchanges: What Makes Sense for Tennesssee? Powerpoint presentation. Tennessee Healthcare Financial Management Association. May 24, 2011. http://www.tn.gov/nationalhealthreform/forms/HC21.pdf3. Press Release. State Insurance Exchange Planning Initiative TAG members.http://www.tn.gov/nationalhealthreform/forms/exhange110810.pdf4.Best Alternatives to a Federal Exchange in Tennessee: A Summary of Stakeholder Feedback. October 21, 2011. State of Tennessee Insurance Exchange Planning Initiative.http://www.tn.gov/nationalhealthreform/forms/fulldocument.pdf5. House Bill 2681/ Senate Bill 2686. http://www.capitol.tn.gov/Bills/106/Bill/SB2686.pdf6. Request for Information. Insurance Exchange Planning Initiative. State of Tennessee.http://tn.gov/generalserv/purchasing/ocr/documents/RFI31865-00709.pdf7. Tennessee Transitional Reinsurance Program: 3Rs Actuarial TAG. DRAFT. April 10, 2012. Gorman Actuarial, LLC. http://www.tn.gov/nationalhealthreform/forms/rrtagpresentation041012.pdf8. Request for Information. State of Tennessee- Insurance Exchange Planning Initiative. March 15, 2012.http://tn.gov/generalserv/purchasing/ocr/documents/RFI31865-00707.pdf9. Exchange Planning Grant Second Quarter Report. May 2, 2011.http://www.tn.gov/nationalhealthreform/forms/planninggrant2ndqtr.pdf10. Enroll UX 2014 website. http://www.ux2014.org/11. Bridge Option: One Family, One Card Across Time. Tennessee Insurance Exchange Planning Initiative. November 21, 2011. http://www.tn.gov/nationalhealthreform/forms/onefamily.pdf12. Tennessee Level One Establishment grant. Department of Finance and Administration. September 30, 2011.http://www.statecoverage.org/files/TN_level1establishmentgrant.pdf

Final update made on November 18, 2013 (no further updates will be made)

Establishing the Marketplace

On December 14, 2012, Governor Terry Branstad (R) informed federal officials that Iowa would pursue a State-federal Partnership Marketplace.¹  Iowa will assume plan management functions in the Marketplace and will continue to perform Medicaid and CHIP eligibility determinations. The state intends to transition to a fully State-based Marketplace in 2016.

Contracting with Plans: The Iowa Insurance Department (IID) is responsible for Qualified Health Plan (QHP) certification and uses the System for Electronic Rate and Form Filing (SERFF) to facilitate the process. Six carriers are certified to participate on Iowa’s Marketplace; four offer plans in the individual Marketplace and five offer small group coverage. Two carriers provide statewide coverage, while the rest participate in smaller regional markets.²  Insurers are allowed to rate by age, tobacco use, and geography; there are seven geographic rating areas in the state.³  Information on plans and rates available to individuals and small businesses can be found on HealthCare.gov.

IID will monitor plan management activities to ensure that QHPs meet quality and performance expectations and will partner with CCIIO to determine the best means of displaying QHP quality reporting to consumers. IID will also perform reviews of form and rate filings, network adequacy, and accreditation, licensure, and solvency standards. Iowa will not require plan standardization.⁴ 

Dental and Vision Benefits: Dental benefits may be embedded in QHPs or offered as stand-alone products.⁵  All insurers offering health insurance coverage in Iowa, both inside and outside the Marketplace, must disclose whether the plan covers pediatric dental benefits.⁶  Plans may have high actuarial value (85%) or low actuarial value (70%). Four dental carriers offer stand-alone dental plans on the Marketplace.⁷  Information on dental plans for individuals and small businesses is available on HealthCare.gov.

Risk adjustment, Reinsurance, and Risk corridors: Iowa has decided to allow the federal government to administer the risk adjustment and reinsurance programs for the Marketplace.⁸ 

Consumer Assistance and Outreach: In May 2012, Governor Branstad signed HF 2645 establishing licensing requirements and criteria for Navigators to be determined by the Insurance Commissioner.⁹  Since Iowa is not engaging in a consumer assistance partnership, the state is not operating an In-Person Assister program and relies on the federally-run Navigator program to provide in-person assistance. In August 2013, the Department of Health and Human Services selected three organizations in Iowa to serve as Navigators and awarded the grantees a total of $599,999 to perform education activities and enrollment assistance for individuals and small businesses.¹⁰  A map of Navigator service areas is available on the IID website. Iowa’s 14 community health centers received a total of $1.5 million in funding from the Health and Resources Services Administration (HRSA) to hire 26 additional workers to support outreach activities and facilitate enrollment.¹¹  Other organizations who wish to assist consumers applying for Marketplace coverage may apply to become volunteer Certified Application Counselors (CACs). Licensed agents and brokers that register and complete the federal training course may sell health insurance coverage through the Marketplace.

In September 2013, the IID held the first in a series of 20 community events to educate consumers about the Marketplace. Events are scheduled statewide and will take place through the end of November.¹²  In October 2013, the IID issued a Request for Proposals (RFP) for a contractor to implement a television and radio advertising campaign using existing advertisements created by the Centers for Medicare & Medicaid Services (CMS). An awardee will be selected in November, and the advertisements will be broadcast from December 1, 2013, through March 31, 2014.¹³  In November 2013, the IID issued a RFP for one or more contractors to develop and implement a statewide outreach campaign targeting uninsured Iowans and small businesses. The outreach campaign will include online, television, and radio advertising; in-person town hall meetings; stakeholder webinar trainings; educational online videos; and a state Marketplace website. The IID will select one or more vendors in mid-December, and the campaign will run from January 2, 2014 through March 31, 2014. If the open enrollment period is extended, the contract will be amended in order to continue the campaign beyond March 2014.¹⁴ 

Small Business Health Options Program (SHOP) Marketplace: In November 2012, the state commissioned a report to review the statutory, regulatory, and administrative SHOP Marketplace requirements and to discuss major design and procurement decisions.¹⁵  Employers with 50 or fewer employees are eligible to participate on the SHOP. In Iowa, 75% of employees must enroll in the SHOP Marketplace in order for the employer to participate.¹⁶  Five carriers offer coverage to small businesses and plans are available on all four metal level tiers.

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 Marketplace, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. Since Iowa has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Wellmark (Blue Cross Blue Shield)- Alliance Select, PPO.

Marketplace Funding

In September 2010, the Iowa Department of Public Health received a federal Exchange Planning grant of $1 million. In November 2011, the Department received a federal Level One Establishment grant of $7.7 million to secure additional staff, identify and begin to establish systems and program capacity, build information technology infrastructure, and initiate a business and operational plan. Iowa received a second Level One Establishment grant for $26.6 million in August 2012, which it planned to use for further development of a new eligibility system. In January 2013, Iowa was awarded a third Level One grant for $6.8 million to develop a consumer assistance program. In October 2013, the state received a fourth Level one grant for $17.5 million to support the transition to a State-based Marketplace in 2016.¹⁷ 

Next Steps

On March 5, 2013, Iowa received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a State-federal Partnership Marketplace.¹⁸  Enrollment into Marketplace coverage began on October 1, 2013. The federal government is operating the online eligibility and enrollment system, and consumers must use the federal portal to apply for coverage online.

For more information on Iowa’s health benefit Marketplace visit: http://www.idph.state.ia.us/HBE/ and http://www.iid.state.ia.us/Exchange

1. Governor Branstad Letter to Secretary Sebelius. December 14, 2012.  ↩︎
2. “Six Health Insurers Apply To Offer Health Care Coverage on Iowa’s Health Insurance Marketplace.” Iowa Insurance Division.  ↩︎
3. Iowa Insurance Division. Geographic Rating Areas.  ↩︎
4. Iowa Design Review Evidence: State Partnership Model, Section 4.0- Plan Management. November 14, 2012. ↩︎
5. Summary Sheet for QHP Application and Stand-alone Dental Plans. Iowa Insurance Division. May 30, 2013. ↩︎
6. Memo re: Treatment of Pediatric Dental Coverage Provided Through Stand Alone Dental Plans. April 26, 2013.  ↩︎
7. “Six Health Insurers Apply To Offer Health Care Coverage on Iowa’s Health Insurance Marketplace.” Iowa Insurance Division.  ↩︎
8. Iowa- Issuer Frequently Asked Questions Risk Adjustment and Reinsurance. Iowa Insurance Division.  ↩︎
9. House File 2465. An Act Relating to State and Local Finances. May 18, 2012. ↩︎
10. Navigator Grant Recipients. Centers for Medicare and Medicaid Services. August 2013. ↩︎
11. The Check-Up. July-October 2013. Iowa Department of Public Health.  ↩︎
12. “IID Kickoff Event for Outreach and Education on Health Exchange Saturday.” Iowa Insurance Division. September 2013. ↩︎
13. Request for Proposal: IID 2013-14 Marketplace-1 Fed Ad Placement. October 18, 2013.  ↩︎
14. Request for Proposal: IID 2013-14 Marketplace-2 Community Outreach Campaign. November 1, 2013. ↩︎
15. Planning for the Small Business Health Options Program. CSG Government Solutions. November 30, 2012.  ↩︎
16. Key Facts About the Small Business Health Options Program (SHOP) Marketplace. Centers for Medicare and Medicaid Services.  ↩︎
17. Iowa Affordable Insurance Exchange Grant Awards List. ↩︎
18. Letter from Secretary Sebelius to Governor Branstad. March 5, 2013.  ↩︎

Final update made on October 1, 2013 (no further updates will be made)

Establishing the Marketplace

On December 20, 2011 the District of Columbia City Council gave final approval to a bill establishing the District of Columbia Health Benefit Exchange Authority (HBX) and in late January 2012, Mayor Vincent Gray (D) signed the legislation into law (Act 19-269).¹  The bill was also subject to a 30-day Congressional review. In June 2013, the District of Columbia announced that its new marketplace would be called DC Health Link.² 

Structure: The legislation defines the District of Columbia Health Benefit Exchange Authority as a quasi-governmental organization, specifically “an independent authority of the District government.”

Governance: DC Health Link is governed by an 11-member board. The Mayor appoints seven voting Board members all of whom are residents of the District of Columbia. Appointments are subject to confirmation by the Council. There are four non-voting ex-officio members, or their designees, the Director of the Department of Health Care Finance (DHCF), the Commissioner of the Department of Insurance, Securities, and Banking, the Director of the Department of Health, and the Director of the Department of Human Services. Each voting Board member will have demonstrated expertise in at least two of the following areas: individual or small employer coverage, health benefits plan administration, health care finance, administering a public or private health care delivery system, purchasing health plan coverage, prior experience in commercial insurance management, actuarial analysis, health care economics, human services administration, health care consumer interest advocacy, public health programs, or enrolling individuals into health benefit plans. At least one voting member must have knowledge of health care consumer interest advocacy.

Members of the Board or of the Marketplace staff cannot share any affiliation with an insurer, an agent or broker, a health professional, or a health care facility or clinic. Board members and Marketplace staff cannot be health care providers, unless they receive no compensation for medical services rendered; and the provider can have no ownership interest in a professional health care practice. Board members and staff cannot be members, board members, or employees of a trade association of carriers, health facilities, health clinics, or health professionals while serving on the Board. Additionally, they cannot accept employment with any carrier that participates on DC Health Link for at least one year after ending their service.

Current appointed Board members are:

• Mohammad Akhter, M.D., DC Department of Health
• Henry J. Aaron, Brookings Institution
• Leighton Ku, Center for Health Policy Research at George Washington University
• Khalid Pitts, Service Employees International Union
• Kate Sullivan Hare, Health Policy Insight & Strategy
• Diane C. Lewis, ALTA Consulting Group (Chair)
• Kevin Lucia, Health Policy Institute of Georgetown University

The Board hired an Executive Director in December 2012. In addition, the legislation calls for an Advisory Board consisting of nine members who are residents of the District to provide recommendations to the Board on issues ranging from insurance standards to covered benefits. The Advisory Board began meeting in January 2013.

The HBX established fifteen Advisory Working Groups to engage consumer and community groups in implementing aspects of the Exchange. Each working group, chaired by a Board member and vice-chaired by a member of the Advisory Board, is tasked with a specific issue to address. Stakeholders attend working group meetings and contribute to developing recommendations for the Board. As of June 2013, all working groups had completed their tasks.³ 

Contracting with Plans: The Board has the authority to “limit the number of plans offered in the exchanges using selective criteria or contracting, provided individuals and employers have an adequate number and selection of choices.” While the legislation grants the HBX the ability to enter into selective contracting with carriers, for the initial launch DC Health Link will contract with all licensed carriers that meet minimum Qualified Health Plan (QHP) requirements. Health plans participating in DC Health Link must offer at least one bronze level, one silver level, and one gold level plan, as well as a child-only plan at the same level of coverage as any other plan offered.⁴   The Department of Insurance, Securities and Banking (DISB) will develop one or more standardized benefit plans at the silver and gold metal levels for the 2015 plan year and for the bronze and platinum metal levels by the 2016 plan year. For each metal level in which they participate, carriers must offer at least one standardized plan.⁵  There will be no limit on the number of Qualified Health Plans (QHPs) sold through DC Health Link. Four insurers will offer a total of 301 products on DC Health Link in 2014, and DISB approved rates for plans sold in the individual and SHOP marketplaces in July 2013. Rates may not be adjusted for tobacco use or geography.

In June 2013, the DC City Council passed legislation requiring carriers to sell all individual and small group products through DC Health Link, effectively dissolving the non-Marketplace individual and small group markets. Individual plans may only be offered through the Marketplace beginning on January 1, 2014, while small group plans have until January 1, 2015 to transition to DC Health Link.⁶  In addition, the SHOP and individual markets will be merged into a single risk pool.⁷ 

In May 2013, the Quality Working Group recommended that the HBX specify the requirements and format for a standardized Quality Improvement Plan (QIP) for 2015, taking into account federal requirements. The working group also recommended that the HBX work with the Maryland and Virginia Marketplaces to standardize the information that their QHPs collect and report through QIPs.⁸  The Board approved the recommendations in June 2013.⁹ 

Carriers must meet the Affordable Care Act’s network adequacy standards in 2014. The HBX will work with DISB to gather network adequacy data and assess where deficiencies remain in order to establish DC-specific network standards by 2016.¹⁰ 

Dental and Vision Benefits: DC’s Exchange authorizing legislation requires DC Health Link to offer stand-alone dental plans. The pediatric essential health benefit may be offered as a stand-alone dental plan, embedded in a QHP, or in conjunction with a QHP as long as the plans are priced separately and are available for purchase separately at the same price.¹¹  Issuers offering stand-alone pediatric dental plans may offer non-pediatric dental plans as well. QHPs are required to make clear whether or not they offer the pediatric dental essential health benefit. In April 2013, the Board approved a $1,000 out-of-pocket maximum for Qualified Dental Plans (QDPs) with one child enrollee and a $2,000 limit for plans with two or more child enrollees.¹² 

Risk adjustment, Reinsurance, and Risk corridors: In April 2012, the HRIC’s Insurance Subcommittee recommended the District opt into a federally administered risk adjustment and reinsurance program for DC Health Link.

Consumer Assistance and Outreach: In April 2013, the Board voted to establish an In-Person Assister (IPA) Program to focus on outreach and enrollment of the uninsured and hard-to-reach populations in all eight of the District’s wards.¹³ 

Grantee organizations will recruit and hire individual assisters, known as DC Health Link Assisters to conduct education and enrollment assistance. In August 2013, the HBX awarded $6.4 million in grant funding to 35 community-based organizations to fund education and enrollment assistance services. Awardees include faith-based organizations, community health care providers, business associations, consumer advocacy groups, and organizations serving those with HIV/AIDS. DC Health Link Assisters must complete five days of training courses (over 30 hours total) and pass daily tests, a final exam, and a criminal background check in order to be certified. By mid-September, 94 assisters had been certified and the Marketplace expects to certify over 100 more assisters in October.¹⁴ 

In June 2013, DC launched partnerships with the DC Chamber of Commerce and the Greater Washington Hispanic Chamber of Commerce to conduct outreach and inform small business owners about the insurance options available to them through DC Health Link.¹⁵  In September 2013, DC Health Link announced a partnership with the city’s professional soccer team, DC United, to raise awareness about the Marketplace among young adults, particularly black and Hispanic men.¹⁶  Also in September, DC Health Link launched a partnership with CVS to raise awareness of the law. All 59 CVS locations in the District of Columbia will provide informational brochures, in English and Spanish, and almost 30 locations will host special enrollment events during which DC Health Link Assisters will be onsite to answer consumer questions and provide enrollment assistance.¹⁷ 

In September 2013, DC Health Link launched a six-month advertising campaign to raise awareness of the DC Health Link Marketplace and inform consumers about how to sign up for coverage. The campaign is focused on advertising in outdoor spaces, such as buses, bus stops, Metro stops, and billboards. The advertisements will be concentrated in neighborhoods with particularly high concentrations of the uninsured. Advertisements for DC Health Link are also featured on cable television, newspapers, radio, and the internet.¹⁸ 

It is expected that when customers need a recommendation for selecting a particular plan, DC Health Link Assisters will refer them to a broker for assistance. In order to sell products on DC Health Link, brokers must be licensed to sell insurance in DC and must complete eight hours of training. Brokers may sell in the individual market and/or the small group market and must be appointed with each carrier offering products in the market(s) they intend to participate in. The Marketplace will not compensate brokers, as they will continue to be paid for their services by insurance carriers.¹⁹ 

In July 2013, the HBX selected a vendor to design, build, staff, and operate the DC Health Link contact center. As of early September, 23 customer service representatives has been hired, a third of whom speak Spanish or Amharic. The contact center opened with a soft launch on September.²⁰ 

Small Business Health Options Program (SHOP) Marketplace: The SHOP Marketplace will be limited to small businesses with 50 or fewer employees in 2014 but will expand to include businesses with up to 100 employees in 2016.²¹  Legislation approved by the DC City Council in June 2013 requires all small business owners to purchase coverage through DC Health Link, as of 2015.²²  SHOP employers may offer their employees all QHPs offered by all issuers in one metal level, all QHPs that one issuer offers in any two contiguous metal levels, or a single QHP offered by one issuer.²³  Employers must contribute at least 50% of the employee’s reference plan premium and must have a participation rate of two-thirds of qualified SHOP employees who do not have another source of coverage.²⁴ 

Financing: The legislation authorizes the Health Benefit Exchange Authority to charge user fees, licensing fees, and other assessments on health carriers selling qualified dental or health plans inside and outside the Marketplace. All revenue will be maintained in a non-lapsing fund to be administered by the Board. In May 2013, the Financial Sustainability Working Group recommended using the existing 2% premium tax and/or the .3% DISB operating assessment to support DC Health Link. If the HBX staff determines this is not feasible or that additional funds are needed, a broad-based assessment on all health insurance premiums should be used.²⁵  In June 2013, the Board approved the recommendation.²⁶ 

Essential Health Benefits (EHB): The Affordable Care Act requires that all individual and small-group plans sold in a state, including those offered through the Marketplace, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. States were encouraged to select the benchmark EHB plan by the end of September 2012. In August 2012, the HRIC’s Insurance Subcommittee released a proposed EHB recommendation for the District which will be considered by the DC Health Link Board and the Mayor after a month of public comment.²⁷  With the help of subcontractors, the Insurance Subcommittee recommended BlueCross BlueShield CareFirst BluePreferred plan as the District’s EHB benchmark plan.

Marketplace Funding

In September 2010, the District of Columbia Department of Health Care Finance received a federal Exchange Planning grant of $1 million. The same Department received a federal Level One Establishment grant of $8.2 million in August 2011 to leverage the data, information, and indicators gathered in the preliminary planning effort into a comprehensive project design. In September 2012, the District of Columbia received a Level Two grant of $73 million to develop an IT system and to fund creation of the DC Health Link Marketplace and the first year of operations.²⁸ 

Next Steps

On December 14, 2012, the District of Columbia received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a State-based Marketplace.²⁹  While consumers are able to enroll in QHPs through the online DC Health Link portal as of October 1, the system is not yet ready to calculate subsidy amounts or to determine Medicaid eligibility. These two functions are expected to become available online around November 1. Consumers who enroll into coverage prior to November 1 and are eligible for subsidies will be notified by email in November.³⁰ 

Additional information on the District of Columbia’s Health Benefit Exchange Authority can be found at: http://hbx.dc.gov/ and and https://www.dchealthlink.com/.

1. D.C. Act 19-269. Enrolled Original. Health Benefit Exchange Authority Establishment Act for the District of Columbia. January 17, 2012. ↩︎
2. “DC Unveils New Name and Logo for Health Insurance Marketplace.” June 13, 2013.  ↩︎
3. Health Benefit Exchange Authority. Advisory Working Groups.  ↩︎
4. DC Health Benefit Exchange Authority. Resolution to establish additional QHP certification standards to promote benefit standardization in the Exchange. March 13, 2013.  ↩︎
5. DC Health Benefit Exchange Authority. Resolution to establish further EHB standards and to establish additional QHP certification standards. March 22, 2013.  ↩︎
6. “Better Prices, Better Quality, Better Choices for Health Coverage Emergency Amendment Act of 2013.” June 2013.  ↩︎
7. DC Health Benefit Exchange Authority. Carrier Reference Manual. June 2013.  ↩︎
8. DC Health Benefit Exchange Authority. Quality Working Group Report. May 29, 2013.  ↩︎
9. DC Health Benefit Exchange Authority. Resolution to establish a strategy for the DC Health Benefit Exchange to improve the quality of care offered by Qualified Health Plans, including through quality reporting requirements. June 6, 2013.  ↩︎
10. DC Health Benefit Exchange Authority. Network Adequacy Working Group Report. March 5, 2013.  ↩︎
11. DC Health Benefit Exchange Authority. Dental Working Group Report. April 13, 2013.  ↩︎
12. DC Health Benefit Exchange Authority. Resolution to establish a reasonable out-of-pocket maximum for Qualified Dental Plans. April 18, 2013.  ↩︎
13. Consumer Assistance and Outreach Advisory Committee. In-Person Assister Recommendations to the DC Health Benefit Exchange Board. April 15, 2013.  ↩︎
14. “First 94 Assisters Complete In-Depth Training to Help DC Residents Shop, Compare and Enroll in Coverage.” September 19, 2013.  ↩︎
15. “DC Exchange Launches New Partnerships with Leading Business Advocates.” June 18, 2013.  ↩︎
16. “DC Health Link Fields Deal with D.C. United.” September 12, 2013.  ↩︎
17. “DC Health Link Partners With CVS/pharmacy to Raise Awareness of Health Law.” September 18, 2013.  ↩︎
18. “Health exchange partners with D.C. United in big campaign.” September 11, 2013.  ↩︎
19. DC Health Benefit Exchange Authority. “Brokers – What You Need to Know to Sell in DC Health Link.” ↩︎
20. DC Health Link. Contact Center Encounter Summary Report. September 2013.  ↩︎
21. DC Health Benefit Exchange Authority. Resolution to establish a transition process for individual and small business health benefit plan enrollees into the Marketplace Exchange. March 13, 2013.  ↩︎
22. “Better Prices, Better Quality, Better Choices for Health Coverage Emergency Amendment Act of 2013.” June 2013.  ↩︎
23. DC Health Benefit Exchange Authority. Resolution to establish the range of plan selection choices for plan year 2014, within the SHOP Exchange. April 4, 2013.  ↩︎
24. DC Health Benefit Exchange. Resolution to establish the minimum employer contribution and minimum employee participation standards within the SHOP. April 8, 2013.  ↩︎
25. DC Health Benefit Exchange Authority. Recommendations of the Working Group on Financial Sustainability. May 23, 2013.  ↩︎
26. DC Health Benefit Exchange Authority. Resolution to establish a financial sustainability plan for the operating costs of the DC Health Benefit Exchange. June 6, 2013.  ↩︎
27. District of Columbia Health Benefits Exchange Insurance Subcommittee. Essential Health Benefits Bulletin. August 29, 2012.  ↩︎
28. District of Columbia Health Insurance Marketplace Grants Awards List. ↩︎
29. Letter from HHS to Mayor Gray. December 14, 2012.  ↩︎
30. “Key Functions of D.C. Health Exchange Delayed.” September 25, 3013.  ↩︎

Final update made on October 8, 2013 (no further updates will be made) 

Establishing the Marketplace

After the legislature failed to pass Marketplace legislation during the 2011 session, Governor Lincoln Chafee (I) signed Executive Order 11-09 on September 19, 2011, to establish the Rhode Island Health Benefit Exchange.¹  In July 2013, Rhode Island announced that its Marketplace would be called HealthSource RI.² 

Recommendations by the Rhode Island Healthcare Reform Commission largely informed the Governor’s decision to issue an Executive Order. After SB 87 failed, the Commission regrouped to continue planning a State-based Marketplace.³  The Commission’s Executive Committee focused on evaluating non-legislative strategies to establish a Marketplace, while the Commission’s Health Insurance Exchange Workgroup began meeting biweekly to form recommendations on policy options to the Executive Committee.

Structure: The Executive Order establishes the Rhode Island Health Benefit Exchange as “a Division within the Executive Department.”

Governance: HealthSource RI is governed by a 13-member board. The Board includes four ex officio members (or their designees): the Director of the Department of Administration; the Health Insurance Commissioner; the Secretary of the Executive Office of Health and Human Services; and the Director of the Department of Health. The Governor appoints nine Board members, two of whom will represent consumer organizations and two to represent small businesses. The remaining appointees will provide demonstrated expertise in a diverse range of health care areas including, but not limited to, individual health care coverage, small employer health care coverage, health benefits plan administration, health care finance and accounting, administering a public or private health care delivery system, state employee health purchasing, electronic commerce, and promoting health and wellness. Board members cannot be affiliated with in any way, an insurer, a health insurance agent or broker, a health care provider, or a health care facility or clinic. No Board member can be a health care provider, unless no compensation is received for services rendered and the provider has no ownership interest in a professional health care practice.

The Board is required to receive guidance from an Expert Advisory Committee comprised of health industry experts, including representatives of insurers, agents and brokers, and providers. The Board also collects feedback from the Commission’s Health Insurance Exchange Workgroup, which allows for stakeholder participation and input on policy decisions.

Current appointed Board members are:

• Margaret Curran (Chair), former United States Attorney for Rhode Island
• Geoffrey E. Grove (Vice-Chair), Pilgrim Screw
• Michael C. Gerhardt, Save The Bay and former Health Insurance Executive
• Margaret Holland McDuff, Family Services of Rhode Island
• Peter Howland, retired Pediatrician
• Linda Katz, The Economic Progress Institute
• Marta Martinez, Progresso Latino
• Dwight McMillan, The Basics Group
• Patrick Quinn, SEIU, Healthcare 1199 New England

In June 2012, the Board hired an Executive Director to oversee all Marketplace activities. The Board has met regularly since October 2011 and receives feedback from the Commission’s Health Insurance Exchange Workgroup and the Expert Advisory Committee. Subcontractors have been solicited to provide technical assistance with business processes, stakeholder support, health plan certification, financial management and oversight, and commercial market activities to support the viability of HealthSource RI.^4 5 

Contracting with Plans: The Marketplace will function as an active purchaser that has “the discretion to determine whether health plans offered through the Exchange are in the interests of qualified individuals and qualified employers.” The Advisory Committee has explored Rhode Island’s options for risk adjustment and reinsurance, noting that legislation will be necessary in the future.⁶ 

HealthSource RI began direct negotiations with carriers in the fall of 2012. All four carriers in Rhode Island expressed interested in selling through HealthSource RI–Blue Cross Blue Shield of Rhode Island, Neighborhood Health Plan of Rhode Island and United Healthcare (SHOP only) filed to offer in 2014 and Tufts Health Plan intends to file for 2015. There are twelve plans offered through the individual market, including four Gold, four Silver, three Bronze, and one Catastrophic offering. Sixteen plans, including three Platinum, six Gold, five Silver, and two Bronze, are available on the small group market.⁷  In June 2013, the Office of the Health Insurance Commissioner approved final forms and rates for individual and small group plans submitted by carriers.⁸  The HealthSource RI Board announced final approval of QHPs for inclusion on the Marketplace in August.⁹  Rates may not differ by geographic area and are effective through December 31, 2014.¹⁰ 

QHPs offered through HealthSource RI will be subject to the same network adequacy standards, established by the Rhode Island Department of Health, that apply to all health plans offered in Rhode Island. These standards include geographic distribution and office hour requirements for primary care providers that go beyond the federal regulations for network adequacy. Network adequacy requirements will be reviewed annually, and the Executive Director of HealthSource RI may establish additional standards, if necessary.¹¹ 

Dental and Vision Benefits: All plans sold through HealthSource RI must include the pediatric dental benefits covered under the pediatric dental EHB Benchmark plan (MetLife Federal Dental) and the pediatric vision benefits covered under the pediatric vision EHB Benchmark plan (FEP Blue Vision). Plans offered outside the Marketplace must also cover the pediatric dental services offered through the EHB Benchmark, unless the policyholder is already covered under a dental plan that offers those services.¹² 

Consumer Assistance and Outreach: In July 2013, HealthSource RI and the Executive Office of Health and Human Services contracted with the Rhode Island Health Center Association (RIHCA)to develop and manage the state’s network of in-person assisters.¹³  RIHCA is responsible for training, certifying, managing, and compensating the network of assisters. In August 2013, RIHCA issued a Request for Proposals (RFP) to solicit a single organization to perform outreach and education activities and a separate RFP for entities to provide one-one-one enrollment assistance. In late September, RIHCA announced the organization selected to perform outreach and 11 community organizations chosen to carry out enrollment assistance activities. In-person enrollment assistance will also be available at each of the state’s eight federally qualified health centers (FQHCs), using federal funding awarded to support outreach and enrollment functions at FQHCs.¹⁴ 

In May 2013, the state selected a vendor to design and establish a consumer contact center,¹⁵  and the center opened in mid-September. In July, the Marketplace launched a consumer-facing website with a subsidy calculator and contracted with a firm to develop and produce a marketing campaign.¹⁶  The advertising campaign began on September 30, including print, television, radio, bus shelter, and billboard advertisements, and is intended to raise awareness of the Marketplace among all Rhode Islanders.¹⁷ 

In July 2013, Rhode Island launched the “39 in 3” campaign, through which HealthSource RI officials visited all 39 Rhode Island cities in three months to educate small employers, community organizations, and individuals about the health coverage options available to them through the Marketplace. In August 2013, Blue Cross Blue Shield of Rhode Island introduced their own education and outreach campaign by launching a website where Rhode Islanders can learn about the health reform law and establishing a partnership with Walgreens to distribute information to in-store and online customers.¹⁸ 

Small Business Health Options Program (SHOP) Marketplace: Small employers with up to 50 employees will be eligible to purchase coverage through the SHOP Marketplace. Employers purchasing coverage through HealthSource RI will either use the full employee choice model, through which employers will give their employees the choice to enroll in the SHOP plan that best meets their needs, or employers may select a single plan for all of their employees.¹⁹ 

HealthSource RI will certify licensed agents and brokers to assist small employers in purchasing coverage on the Marketplace. In order to participate on the Marketplace, producers must complete a training program, pass an examination, and receive notification of certification from HealthSource RI. The initial certification period is two years and will end on December 31, 2015. Producers will be compensated by issuers and will not receive any payment from HealthSource RI.²⁰ 

Financing: The Executive Order authorizes the Marketplace to receive funds from insurers or other entities, including the United States Department of Health and Human Services, but it cannot use state general revenue funds. The Board will determine how the funds are to be received from insurers and the amounts.

Essential Health Benefits (EHB): The Affordable Care Act requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Marketplace, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. In September 2012, the state recommended Blue Cross Blue Shield of Rhode Island- Vantage Blue PPO to serve as the benchmark plan.²¹ 

Marketplace Funding

The Rhode Island Department of Business Regulation received a federal Exchange Planning grant of $1 million in 2010 and was awarded a $5.2 million federal Level One Exchange Establishment grant in May 2011 to “strengthen health information technology systems, develop an integrated consumer support program to provide support to individuals and small businesses, and strengthen its business operations.” In addition, Rhode Island is a member of the consortium of New England states that received a federal Early Innovator grant of $44 million to develop, share, and leverage Marketplace technology. The multi-state consortium also includes Connecticut, Maine, Vermont, and Massachusetts with the University of Massachusetts Medical School as the grant holder. In November 2011, Rhode Island received the first Level Two Exchange Establishment grant. The $58.5 million grant will fund the development, design, and technology procurement of HealthSource RI through December 2014.²² 

Rhode Island, along with nine other states, is receiving technical assistance from the Robert Wood Johnson Foundation through the State Health Reform Assistance Network; this assistance includes help with setting up health insurance Marketplaces, expanding Medicaid to newly eligible populations, streamlining eligibility and enrollment systems, instituting insurance market reforms and using data to drive decisions.²³ 

Next Steps

On December 20, 2012, Rhode Island received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a State-based Marketplace.²⁴  The HealthSource RI Marketplace portal became operational on October 1 and began enrolling qualified individuals, families, and small businesses into coverage.

Additional information about HealthSource RI can be found at: http://www.healthsourceri.com/

1. Executive Order 11-09. Establishment of the Rhode Island Health Benefits Exchange.  ↩︎
2. “Rhode Island’s Obamacare marketplace will open Oct. 1 as HealthSource RI.” July 15, 2013. ↩︎
3. SB87. Rhode Island’s bill to establish a health benefit exchange in 2011.  ↩︎
4. Rhode Island Level One Establishment grant application. Funding Opportunity IE- HBE-11-004.  ↩︎
5. Request for Proposals #7449222: Health Insurance Exchange Technical Assistance. November 9, 2011.  ↩︎
6. Risk Adjustment and Reinsurance. Rhode Island Health Benefits Exchange Expert Advisory Committee. November 22, 2011.  ↩︎
7. Rhode Island Health Benefits Exchange. Update on Qualified Health Plan Filings: Advisory Board Briefing. May 15, 2013.  ↩︎
8. Office of the Health Insurance Commissioner. “OHIC Approves Commercial Health Insurance Contracts, Rates and Rate Factors.” June 28, 2013.  ↩︎
9. “HealthSource RI Announces Approved Plans and Rates.” August 21, 2013.  ↩︎
10. Office of the Health Insurance Commissioner Regulation 17– Filing and Review of Health Insurance Plan Forms and Rates. ↩︎
11. Letter from Michael Fine, Department of Health, to Christopher Koller, Health Insurance Commissioner, and Christine Ferguson, Director RI Health Benefits Exchange. January 11, 2013. ↩︎
12. Checklist for Individual and Small Group Health Insurance Plans- Policy Form. ↩︎
13. Request for Proposals: Rhode Island Outreach and Enrollment Support Program (OESP): Network Manager. May 2, 2013. ↩︎
14. “Community organizations to help explan new health insurance options.” September 24, 2013.  ↩︎
15. Request for Proposals: Rhode Island Health Insurance Contact Center. March 20, 2013.  ↩︎
16. HealthSource RI. Communications Plan Launch Messaging & Activities July-August. July 16, 2013. ↩︎
17. “Ad campaign uses R.I.’s pioneering past to spur interest in health exchange.” September 30, 2013.  ↩︎
18. “Blue Cross launches health reform education campaign.” August 14, 2013.  ↩︎
19. HealthSource RI. Plans and Rates for HealthSource RI 2014. August 20, 2013.  ↩︎
20. HealthSource RI. HealthSource RI Small Business Health Options Program Agent/Broker Agreement. October 2013. ↩︎
21. Office of the Health Insurance Commissioner. Benchmark Plan selection.  ↩︎
22. Rhode Island Affordable Insurance Exchange Awards List. CCIIO.  ↩︎
23. Robert Wood Johnson Foundation. ‘RWJF Seeks Coverage of 95 Percent of All Americans by 2020.’ May 6, 2011.   ↩︎
24. Letter from Governor Chafee to Kathleen Sebelius. July 5, 2012.  ↩︎

Final update made on March 21, 2013 (no further updates will be made)

Establishing the Exchange

After placing health insurance exchange planning on hold until after the November elections, Governor Sam Brownback (R) announced on November 9, 2012, Kansas would default to a federally-facilitated exchange.^1,2

With the initial endorsement of the Governor in 2011, Kansas Insurance Commissioner Sandy Praeger, had established eight exchange planning work groups comprised of hundreds of volunteers across civic groups, government agencies, and the insurance and health care industries. The work groups met regularly from the spring of 2011. The work groups reported to the Health Benefit Exchange Steering Committee, housed within the Insurance Department. Work group reports adopted by the Steering Committee include recommendations regarding oversight of navigators, limiting the number of insurance carriers in the exchange, the role of agents and brokers, the number of exchanges the state should have, and a consumer outreach and education plan.³

In May 2011, Governor Brownback signed into law a measure prohibiting health plans operating within a Kansas exchange from offering abortion services unless the pregnant woman’s life is in danger (HB 2075).⁴ The purchase of optional riders for abortion coverage in these plans is not allowed.

Contracting with Plans: On February 15, 2013, Commissioner Praeger sent a letter to the Center for Consumer Information and Insurance Oversight (CCIIO) requesting to maintain control over plan management functions despite not having entered into a state-federal partnership exchange. The Kansas Insurance Department (KID) intends to utilize the System for Electronic Rate and Form Filing (SERFF) to review health plan rates, covered benefits, and cost-sharing requirements for purposes of certifying qualified health plans (QHPs). KID will also manage consumer complaints, ensure continued plan compliance, and oversee decertification of issuers. Commissioner Praeger attested that Kansas has the legal authority to conduct plan management functions necessary to support certification of QHPs, as required by the Affordable Care Act.⁵

Essential Health Benefits (EHB): The Affordable Care Act requires that all individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. In October 2012, the Insurance Department submitted an EHB benchmark plan recommendation to the Governor of Blue Cross Blue Shield of Kansas Comprehensive Plan.⁶

Exchange Funding

In September 2010, the Kansas Insurance Department received a $1 million federal Exchange Planning grant. The Department also received a $31.5 million federal Early Innovator grant to develop an exchange information technology infrastructure that could be replicated by other states. The state planned to extend the new Kansas Medicaid/Children’s Health Insurance Program eligibility system to provide eligibility and enrollment services for an exchange.⁷ However, on August 9, 2011, the Governor announced the state would return all Early Innovator grant funding.⁸

Next Steps

On March 8, 2013, Kansas received approval from CCIIO to perform plan management activities. The federal government will retain control over all other Exchange functions.⁹

For additional information on the Kansas health insurance exchange visit:http://www.ksinsurance.org/consumers/healthreform/aca.htm

1. Wistrom, Brent. “Brownback: Kansas won’t partner with federal government on health insurance exchange.” November 8, 2012. The Wichita Eagle. http://www.kansas.com/2012/11/08/2561344/brownback-kansas-wont-partner.html2. Twiddy, David. “Health reform ruling divides Brownback, insurance agency on Exchanges.” Kansas City Business Journal. July 6, 2012. http://www.bizjournals.com/kansascity/print-edition/2012/07/06/health-reform-ruling-divides.html?page=all3. Reference Materials for the 2011 Special Legislative Committee on Financial Institutions and Insurance. November 14, 2011 Testimony and October 24, 2011 Testimonyhttp://www.ksinsurance.org/hbexplan/instandinsurance10242011.php (Accessed January 25, 2012)4. House Bill 2075. Approved by the Governor May 25, 2011. http://www.kslegislature.org/li/b2011_12/year1/measures/documents/hb2075_enrolled.pdf5. Letter from Commissioner Praeger to Gary Cohen. February 15, 2013. http://cciio.cms.gov/Archive/Technical-Implementation-Letters/ks-exchange-letter-2-15-2013.pdf6. Kansas Insurance Department. Letter from Sandy Praeger Insurance Commissioner to Governor Sam Brownback. September 24, 2012. http://www.statereforum.org/sites/default/files/lt_governor_re_ehb_analysis_09-24-2012.pdf7HealthCare.gov. “States Leading the Way on Implementation: HHS Awards “Early Innovator” Grants to Seven States.” http://www.healthcare.gov/news/factsheets/exchanges02162011a.html (Accessed August 18, 2011)8. Millman, J. and Nocera, K. “Kansas returns $31.5M exchange grant.” Politico. August 9, 2011. http://www.politico.com/news/stories/0811/60967.html9. Letter from Gary Cohen to Commissioner Praeger. March 8. 2013. http://cciio.cms.gov/Archive/Technical-Implementation-Letters/ks-pm-letter-3-8-2013.pdf

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

Establishing the Exchange

Governor Bobby Jindal (R) announced that Louisiana will not pursue the establishment of a state-based health insurance exchange and instead will allow the federal government to operate an exchange in the state.¹ While a bill establishing an exchange was introduced in the 2012 legislative session, it was not supported by the Governor and failed when the legislative session ended (SB 744).^2,3 Prior to the announcement that the state would not operate its own exchange, Governor Jindal signed into law a bill prohibiting plans operating in a state-based exchange from offering abortions, with no exceptions (HB 1247).⁴

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 Louisiana 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 Louisiana- GroupCare PPO

Exchange Funding

In September 2010, the Louisiana State Department of Health and Hospitals was awarded an almost $1 million federal Exchange Planning grant; the Department announced in March this money would be returned to the federal government.⁵

Next Steps

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

1. Barrow, Bill. “Jindal Takes Stage in GOP Initiative Against Health Law.” The Times-Picayune, July 2, 2012. http://www.nola.com/politics/index.ssf/2012/07/jindal_takes_stage_in_gop_init.html.2. Senate Bill 744. Regular Session 2012. Creates the Louisiana Health Insurance Exchange.http://www.legis.state.la.us/billdata/streamdocument.asp?did=7949473. Barrow, Bill. “Louisiana Senate Panel Sinks Plan to Set Up Health Insurance Exchange.” The Times-Picayune, May 16, 2012.http://www.nola.com/politics/index.ssf/2012/05/louisiana_senate_panel_sinks_p.html4.House Bill 1247. Regular Session, 2010. http://www.legis.state.la.us/billdata/streamdocument.asp?did=7229615. Moller, J. ‘Louisiana to opt out of health insurance exchanges in federal law.’ The Times-Picayune. March 23, 2011.http://www.nola.com/politics/index.ssf/2011/03/louisiana_to_opt_out_of_health.html