Final update made on September 27, 2013 (no further updates will be made) 

Establishing the Marketplace

On July 1, 2011, Governor Dan Malloy (D) signed SB921 (Public Act 11-53) into law establishing the Connecticut Health Insurance Exchange.¹   Legislation altering the composition of the Exchange Board passed in June 2012.^2 3  In December 2012, the Exchange announced that its new name would be “Access Health CT.”

Structure: The legislation defines Connecticut’s Health Insurance Exchange as a quasi-governmental organization, specifically “a body politic and corporate, constituting a public instrumentality and political subdivision of the state…which shall not be construed to be a department, institution or agency of the state.”

Governance: Access Health CT is governed by a 14-member board including six ex-officio members. Elected officials appoint eight of the twelve voting members. The Governor appoints two members, one with expertise in individual health insurance coverage and one with expertise in small employer health insurance coverage; the President pro tempore of the Senate appoints an expert in health care finance; the Speaker of the House of Representatives appoints someone knowledgeable in health care benefits plan administration; the Majority Leader of the Senate appoints an expert in health care delivery systems; the Majority Leader of the House of Representatives appoints a health care economist; the Minority Leader of the Senate appoints a person with expertise in health care access issues facing self-employed individuals; and the Minority Leader of the House appoints someone knowledgeable in barriers to individual health care coverage. The four voting ex officio Board members (or their designees) include, the Commissioner of Social Services, the Special Advisor to the Governor on Healthcare Reform, the Healthcare Advocate, and the Secretary of the Office of Policy and Management; non-voting ex officio Board members (or their designees) include, the Insurance Commissioner and the Commissioner of Public Health.

Board members cannot have affiliations with any of the following entities while on the Board: an insurer, an insurance producer or broker, a health care provider, a health care facility or clinic, or trade associations for these entities. Also, members cannot be health care providers receiving compensation for services nor have ownership interest in a professional health care practice. These conflicts of interest provisions apply to Marketplace staff as well as the Board, though Board Members are also prohibited from working for a health care carrier that offers a plan through the Marketplace for the year after serving on the Board.

Current appointed Board members are:

• Nancy Wyman (Chair), Lieutenant Governor
• Mary Fox, formerly with Aetna Product Group
• Robert Scalettar, MD, formerly with Anthem Blue Cross Blue Shield
• Bob Tessier, Connecticut Coalition of Taft Hartley Health Funds
• Cecilia Woods, Permanent Commission on the Status of Women
• Grant Ritter, Schneider Institutes for Health Policy at Brandeis University
• Paul Philpott, Quo Vadis Advisors, LLC
• Maura Carley, Healthcare Navigation, LLC

The Board hired its first Marketplace CEO in June 2012 after holding meetings for nearly a year prior. Consumer groups continue to express concerns that a number of Marketplace Board members have close affiliations with the insurance industry while consumers and small businesses remain under represented.^4 5 

Connecticut’s Exchange legislation requires the Marketplace Board to report annually to the Governor and General Assembly on a variety of issues. The Board must also make any necessary legislative recommendations to reduce the negative impact on the sustainability of the Marketplace. The first annual draft report by the Marketplace Board to the General Assembly was released in January 2012 and updated in February.⁶ 

Advisory committees established in March 2012 meet monthly to assist in Marketplace policy development and evaluation in four key areas: health plan benefits and qualifications; Small Business Health Options Program (SHOP); consumer experience and outreach; brokers, agents, and Navigators.Contracting with Plans: The Marketplace has the legal authority to function as an active purchaser, “limit[ing] the number of plans offered, and us[ing] selective criteria in determining which plans to offer, through the exchange, provided individuals and employers have an adequate number and selection of choices.” In October 2012 however, the Board decided to allow any (Qualified Health Plan) QHP meeting selected criteria to be sold on Access Health CT for 2014. The Marketplace acknowledges that for 2015 and later, they can still opt for a competitive bidding process and develop selective contracting criteria.⁷ 

The legislation does not describe the contracting requirements, but requires the Board to adopt written procedures to explain requirements for certification of qualified health plans. At a minimum, carriers participating in Access Health CT must offer one standard plan for each of the bronze, silver, and gold tiers. Issuers in both Marketplaces may opt to offer a standard plan for the platinum tier, and issuers in the individual Marketplace may choose to offer a catastrophic coverage plan. Plans participating in the individual Marketplace must submit three silver alternative standard plans that reflect cost sharing reductions, two zero cost-sharing plans for American Indians, and a child-only plan.⁸  Plans offered within the Marketplace must charge the same premium as when offered outside the Marketplace, whether sold by an insurance producer or directly by the carrier. Carriers must publicly justify any increase in premiums of plans offered within the Marketplace.

Issuers may choose to participate in the individual Marketplace, the SHOP Marketplace, or both. Issuers meeting certification standards will be certified to participate on Access Health CT for two years; however, issuers that stop participating will not be allowed to re-enter the Marketplace for at least two years. Four carriers were certified to offer coverage through Access Health CT, but in August 2013, one carrier withdrew.⁹  QHP benefits and plans must be filed and certified annually.¹⁰  The Connecticut Insurance Department (CID) is responsible for reviewing and approving rate filings and rate increases. Issuers may rate based on age and geography, but tobacco rating will be prohibited in the individual market for 2014. In August 2013, the CID approved final rates for plans that will be offered through the individual and SHOP Marketplace.

Provider networks for each QHP must meet Utilization Review Accreditation Commission (URAC) or National Committee for Quality Assurance (NCQA) standards and satisfy the requirements of the Special Rules For Network Plans of the Public Health Service Act. Issuers must ensure that the network of providers for standard plan offerings is comparable to the network of providers available for a similar product offered outside Access Health CT. The network must also include a sufficient number of Essential Community Providers and providers that specialize in mental health and substance abuse services.

Issuers will be required to report quality information to Access Health CT, as well as results from the enrollee satisfaction survey system developed by HHS. Access Health CT will use the information to develop and maintain a quality rating system that will relate quality of care to price, per metal-level tier.¹¹ 

Risk Adjustment, Reinsurance, and Risk Corridors: Connecticut intends to administer its risk adjustment and reinsurance programs.¹²  In June 2012 Governor Malloy signed Public Act 12-166 into law establishing the requirement for an all-payer claims database (APCD), which will  provide data to state agencies, including the Marketplace, for purposes of reviewing health care utilization, cost, and quality data. Such a database will provide the baseline information to create a risk adjustment program, as well as to provide outcome quality data and enable analyses of Marketplace policy initiatives. The Office of Health Reform and Innovation is developing the APCD program and established an APCD Advisory Group to guide the implementation process. Access Health CT received $6.5 million in Establishment Grant funding for the APCD program in August 2012.¹³  The APCD Advisory Group released a Request for Proposals (RFP) for a data manager in late July of 2013 and will select a vendor in November. The APCD is expected to be operational and collecting monthly data submissions by August of 2014.¹⁴ 

Dental and Vision Benefits: In order to offer a stand-alone dental plan through the Access Health CT Marketplace, issuers must provide three plan design options: high (85% Actuarial Value), low (75% Actuarial Value), and wellness (limited set of preventive and diagnostic services). Access Health CT requires all carriers submitting a QHP to separately price their pediatric dental essential health benefit.

Consumer Assistance and Outreach: In August 2013, Access Health CT awarded grants to six regionally-based Navigator organizations that will be responsible for developing and implementing regional outreach strategies. Navigators will also provide support and direction to Assisters in their region. The Access Health CT Marketplace has awarded $6,000 grants to approximately 300 Assisters statewide who work at community-based organizations and will provide one-on-one education and enrollment services to consumers. Assisters are distributed based on concentrations of the uninsured throughout the state. Navigators and Assisters must complete up to 40 hours of training, pass a certification test and a background check, and carry photo identification badges.¹⁵  In February 2013, Access Health CT contracted with a vendor to build and service the call center, and the call center launched in September. Over 70 call center representatives are available to serve consumers seeking information about coverage through Access Health CT.¹⁶ 

Brokers who intend to sell coverage through the Access Health CT Marketplace must complete a certification program as well as a training program specific to the market in which they wish to sell (individual and/or SHOP). They must pass a comprehension test after completing the training curricula.¹⁷  As of mid-September, over 600 brokers had been certified and trained.¹⁸ 

In November 2012, Access Health CT hired a marketing vendor and developed a marketing and community outreach plan and timeline. The outreach campaign includes the use of media, direct mail, in-person events, social media, public relations, and brokers.¹⁹   In February 2013, Access Health CT unveiled their logo and launched their website, including a subsidy calculator. In mid-June, Access Health CT launched a marketing campaign, including television, print, outdoor, and online advertising, to raise awareness about the Marketplace. Access Health CT also began community outreach efforts in June and connected with almost 7,000 individuals, half of whom will qualify for subsidies through the Marketplace, at fairs, festivals, concerts, retail outlets, and “Healthy Chat” events.²⁰  In September 2013, the Marketplace launched a television series titled Mercado de Salud, that will engage and educate the Hispanic community about Access Health CT.²¹  Access Health CT is also working to build two Marketplace retail locations, where consumers will have access to in-person education and enrollment services. The storefronts are expected to open in mid-October.

Small Business Health Options Program (SHOP) Marketplace: In 2012, the Access Health CT Board decided to establish separate risk pools for the small group and individual markets but to use a single administrative Marketplace to operate both programs. The Board also decided Connecticut should limit the definition of small employers to groups of 50 or fewer employees until it is required to expand the definition to groups of 100 or fewer employees in 2016.²²  Employers will be able to choose between employee choice, employer choice, and sole source coverage models for their employees. In April 2013, Access Health CT hired a subcontractor to develop and manage the front-end and administrative platform for the SHOP. Access Health CT plans to launch the SHOP on October 1, 2013, despite the decision by HHS to allow states to delay implementation until 2015.

Financing: Public Act 11-53 authorizes the Marketplace to charge health carriers capable of offering a qualified health plan through Access Health CT an assessment or user fee. In May2013, the Board approved a 1.35% marketplace assessment on all small group and individual market insurers, as well as dental carriers.²³  The assessment rate is based on Access Health CT’s estimated annual operating cost of $34.5 million.²⁴ 

Basic Health Program (BHP): Connecticut is considering establishing an optional bridge program available through the Affordable Care Act (ACA) which 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 the Marketplace. The Office of Health Reform and Innovation established Work Groups, including one on the Basic Health Program, which began meeting in April 2012 to develop recommendations. Legislation establishing a Basic Health Program was introduced but tabled for the 2012 legislative session (HB 5450).²⁵  Due to the lack of federal guidance, it has been difficult for the state to move forward with planning a BHP.²⁶ 

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. The Access Health CT Board recommended the state use ConnectiCare’s HMO plan as the benchmark plan, the Children’s Health Insurance Program (CHIP) as the pediatric dental supplement, and the Federal Employee Vision Plan (FEDVIP) as the pediatric vision supplement.²⁷ 

Marketplace Funding

The Connecticut State Office of Policy and Management received a federal Exchange Planning grant of $1 million in September 2010 and a federal Level One Establishment grant of $6.7 million in August 2011 to work on IT systems and develop appropriate capacity for consumer assistance and reporting requirements. The state filed a Level One grant application request for $21.9 million in September 2013. The Exchange was awarded a Level Two Establishment grant in August 2012 for $107.3 million to fund Exchange development through December 2014. In February 2013, the state was awarded a second Level One Establishment grant for $2.1 million to fund the implementation of an In-Person Assisters program.²⁸ 

In addition, Connecticut 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 insurance exchange technology. The multi-state consortium also includes Rhode Island, Maine, Vermont, and Massachusetts with the University of Massachusetts Medical School as the grant holder.²⁹ 

Next Steps

On December 7, 2012, Connecticut received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a State-based Marketplace.³⁰  The Access Health CT Marketplace portal will become operational on October 1 and will begin enrolling qualified individuals, families, and small businesses into coverage.

Additional information about Access Health CT can be found here.

1. SB921, Connecticut’s 2011 Health Insurance Exchange Act.  ↩︎
2. HB 5013. An Act Concerning the Board Members of the Connecticut Health Insurance Exchange. February Session, 2012.   ↩︎
3. Bill No. 6001. An Act Implementing Provisions of the State Budget for the Fiscal Year Beginning July 1, 2012.  ↩︎
4. Bordonaro, Greg. “CT group pushes health exchange shakeup.” November 30, 2011. Hartford Business.  ↩︎
5. McQuaid, Hugh. ‘McKinney to Advocates: Time to Blame Someone Else.’ June 13, 2012. CT News Junkie.   ↩︎
6. Draft Exchange Plan: Recommendations for the Successful Implementation of the Connecticut Health Insurance Exchange. 2/1/12.  ↩︎
7. Memorandum Plan Management Overview. Connecticut Health Insurance Exchange. October 10, 2012.  ↩︎
8. Access Health CT. Initial Solicitation to Health Plan Issuers For Participation in the Individual and SHOP Exchanges. April 6, 2013.   ↩︎
9. “In Wake of Aetna’s Decision to Withdraw from the Exchange, CEO Kevin Counihan says the Exchange ‘retains broad choice for consumers.'” August 5, 2013.   ↩︎
10. Access Health CT. Initial Solicitation to Health Plan Issuers For Participation in the Individual and SHOP Exchanges Questions and Answers. April 19, 2013.  ↩︎
11. Access Health CT. Initial Solicitation to Health Plan Issuers For Participation in the Individual and SHOP Exchanges. April 6, 2013.   ↩︎
12. Access Health CT. Board of Director’s Meeting. April 18, 2013.  ↩︎
13. Connecticut Health Insurance Exchange Plan. Calendar Year Update. January, 2013.  ↩︎
14. Access Health CT. Connecticut APCD Advisory Group Quarterly Meeting. June 25, 2013.  ↩︎
15. “Access Health CT’s Navigator and Assister Outreach Program reaches consumers in their communities. August 23, 2013.   ↩︎
16. “Access Health CT Opens Call Center.” September 3, 2013.  ↩︎
17. “Access Health CT Has Great News for Brokers Looking to Expand Business.” August 19, 2013. ↩︎
18. Access Health CT. Board of Director’s Meeting. September 19, 2013.  ↩︎
19. Access Health CT. Marketing and Community Outreach Plan Introduction. March 6, 2013.  ↩︎
20. Access Health CT. Board of Director’s Meeting. September 19, 2013.  ↩︎
21. “Access Health CT Launches MERCADO DE SALUD.” September 3, 2013.   ↩︎
22. Connecticut Health Insurance Exchange Plan. Calendar Year Update. January, 2013.  ↩︎
23. “New health insurance fee will raise $26 million.” June 3, 2013. ↩︎
24. Access Health CT. Board of Director’s Meeting. May 16, 2013.  ↩︎
25. HB 5450. 2012 Legislative session.  ↩︎
26. Letter to HHS from Governor Malloy. October 12, 2012.  ↩︎
27. Connecticut Health Insurance Exchange. Board of Directors Meeting. September 27, 2012.  ↩︎
28. Connecticut Affordable Insurance Exchange Grants Awards List.  ↩︎
29. Early Innovator Grant Awards. HHS announcement. February 16, 2011. (Accessed August 23, 2011) ↩︎
30. Letter from HHS to Governor Malloy. December 7, 2012.  ↩︎

Final update made on December 14, 2012 (no further updates will be made)

Establishing the Exchange

In December 2012, Governor Rick Scott (R) announced that Florida would not be pursuing efforts to implement a state-based health insurance exchange.¹ Governor Scott has been a vocal opponent of federal health reform and the state has refused multiple funding opportunities available through the Affordable Care Act (ACA).² Florida was also the lead plaintiff in a lawsuit brought by 26 states seeking to declare parts of federal health reform unconstitutional.³

At the same time, Florida has been proceeding with an initiative, Florida Health Choices, to create a new marketplace for small businesses that predates the passage of federal health reform.^4,5The initiative, begun in 2008 with the enactment of SB 2534, will include a web portal where employers with 50 or fewer employees and some individuals, such as state retirees, can shop for health plans offered in their county.^6,7 The state provided a one-time appropriation of $1.5 million for start-up funding, with on-going support provided through a fee of 2% of the premium for every policy sold through the marketplace paid by participating health plans and a $300 annual payment from agents who sell policies through the marketplace. Florida Health Choices has appointed a Board of Directors, hired staff, and appointed two steering committees to advise the Board- one for vendors and another for agents. In May of 2012, Florida Health Choices identified a third party administrator to provide a web portal, online plan selection tools, and a statewide customer contact center.⁸ In September 2012, the state began beta testing the web portal.⁹ Florida Health Choices does not currently comply with provisions in the ACA, such as providing subsidies to assist eligible low-income individuals with purchasing insurance or mandating that health plans sold through the exchange cover certain health benefits.

In 2011, the Governor signed HB 97/SB 1414, which prohibits coverage of abortions when insurance is purchased through an exchange using state or federal funds, except in cases of rape, incest, or life endangerment of the pregnant woman.¹⁰ The legislation allows health insurance policies to offer separate coverage for abortions not purchased with state or federal funds.

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 Florida 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 Florida- BlueOptions, PPO.

Exchange Funding

Florida’s Agency for Health Care Administration received a federal Exchange Planning grant of $1 million in 2010, but has since returned the grant.¹¹

Next Steps

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

1. Young, Jeffrey. “Obamacare: Florida GOP Gov. Rick Scott Won’t Implement health Care Reform.” HuffingtonPost. December 14, 2012. http://www.huffingtonpost.com/2012/12/13/obamacare-2. “Florida Shuns Funds Tied to Health Care Reform.” Florida Today. March 26, 2012.http://www.wtsp.com/news/article/247143/19/Florida-shuns-funds-tied-to-health-care-reform3. Baribeau S. “Florida’s Scott May Press for U.S. Health Aid.” Bloomberg. August 9, 2011.http://www.bloomberg.com/news/2011-08-09/florida-s-scott-may-press-for-u-s-health-aid.html4. Scott, Rick. “ObamaCare: One Year Too Many.” http://www.flgov.com/2012/01/03/obamacare-one-year-too-many/5. Galewitz P. “Florida to Launch Its Own Health Insurance Marketplace.” The Washington Post. October 8, 2011.http://www.washingtonpost.com/national/health-science/florida-to-launch-its-own-health-insurance-marketplace/2011/10/07/gIQA1Ns8VL_story.html6. SB 2534 (Chapter 2008-32). Florida act related to health insurance and Cover Florida Health Care Access Program. 2008. http://laws.flrules.org/files/Ch_2008-032.pdf7. See: http://myfloridachoices.org/about/8. Florida Health Choices Names Xerox as Program Administrator.” May 2012. Health Choices.http://myfloridachoices.org/florida-health-choices-names-xerox-as-program-administrator/9. See Florida Health Choices: https://www.floridahealthchoices.com/10. HB 97/SB 1414 (Chapter 2011-11). Florida’s 2011 act related to health insurance.http://laws.flrules.org/files/Ch_2011-111.pdf11. Baribeau S. “Florida’s Scott May Press for U.S. Health Aid.” Bloomberg. August 9, 2011.http://www.bloomberg.com/news/2011-08-09/florida-s-scott-may-press-for-u-s-health-aid.html

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

Establishing the Exchange

In November 2012, Governor-elect Mike Pence (R) announced that he would not move forward with setting up a state-based health insurance exchange when he takes office in 2013.¹

During his term, Governor Mitch Daniels (R) had signed Executive Order #11-01 in 2011 to conditionally establish and operate the Indiana Insurance Market, Inc., a nonprofit corporation to serve as the Indiana health insurance exchange.² The Executive Order defined Indiana’s exchange as a nonprofit incorporated by the Secretary of the Indiana Family and Social Services Administration, working with the Indiana Department of Insurance. An interagency group including, the Department of Insurance, the Family and Social Services Administration, and the Office of Medicaid Policy and Planning, worked on exchange planning in the state. However, since issuing the Executive Order, Indiana began to move away from a state-based exchange.³ While the state had assembled two pieces of draft exchange legislation, the Department of Insurance did not propose either during the 2012 legislative session, which ended in March 2012.⁴

On May 5, 2011, Governor Daniels signed HB 1210, which prohibits qualified health plans purchased through an exchange in Indiana from covering abortions, except in the case of rape, incest, or to avert impairment or death of the pregnant woman.⁵

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 Indiana has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Anthem Blue Cross Blue Shield of Alaska- Blue Access PPO.

Exchange Funding

In May 2011, Indiana was among the first three states to be awarded a federal Level One Establishment grant.⁶ The Indiana Department of Insurance and Family and Social Services Administration received of $6.9 million to update their information technology systems, develop a financial management plan, and acquire legal, actuarial, and financial expertise.⁷ The Indiana Family and Social Services Administration also received a federal Exchange Planning grant of $1 million in September 2010.

Next Steps

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

Additional resources related to Indiana’s exchange planning can be found at:http://www.nationalhealthcare.in.gov

1. Gov-Elect Pence: Indiana Should Not Establish State-based health insurance exchange. November 15, 2012. http://www.mikepence.com/exchange2. Indiana Executive Order #11-01. January 2, 2011.http://www.in.gov/gov/files/Executive%20orders/EO_11-01.pdf3. State of Indiana Letter to CMS. Comment on State Exchange Plan Application. January 10, 2012. http://www.in.gov/aca/files/Indiana_Exchange_Certification_Application_Comments.pdf4. Level One Establishment Grant Quarter 1 Report. 10/30/2011.http://www.in.gov/aca/files/HIX_Level_One_Quarterly_Report.pdf5. HB 1210 (Chapter 33). Indiana’s 2011 act related to Health Care Exchanges and Abortion.http://www.in.gov/legislative/bills/2011/HE/HE1210.1.html6. Indiana Health Insurance Exchange Level One Funding Solicitation.http://www.statecoverage.org/files/IN_InsuranceMarketGrantITGAPSummary_2011.pdf7. HealthCare.gov. “Creating a New Competitive Marketplace: Affordable Insurance Exchange Establishment Grant Awards List.” August 12, 2011.http://www.healthcare.gov/news/factsheets/exchanges05232011a.html

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

Establishing the Exchange 

On December 7, 2012, Governor Chris Christie (R) vetoed A 3186/S 2135, which would have established a health insurance exchange within the Department of Banking and Insurance and announced that the state would default to a federal exchange.¹Governor Chris Christie (R) vetoed similar legislation earlier in 2012.²

In 2011, the New Jersey Interagency Working Group on the ACA, led by the Health Care Policy Advisor to the Governor, had contracted with Rutgers University’s Center for State Health Policy to assist in the planning effort. In December 2011, the Center for State Health Policy released a summary of a multi-stakeholder forum convened to examine governance options for a New Jersey exchange.³ The results of the forum build on the Center’s compilation of stakeholder views of a state-based exchange released in August 2011.⁴ Though there was agreement that the state should establish an exchange, there was less consensus around the composition of the governing board and whether the exchange should be an active purchaser or clearinghouse.⁵

At the same time, the New Jersey Department of Banking and Insurance and the Robert Wood Johnson Foundation funded the Center for State Health Policy, in collaboration with Seton Hall University School of Law, to examine critical exchange design issues. The Center, completed a policy analysis of governance options and released a report recommending that New Jersey establish an exchange as a government agency, overseen by a Board of Directors with seven to nine members, and guided by insight from a larger advisory board.⁶ The Center released several additional reports on numerous topics: merging the non-group and small-group risk pools, establishment of a defined contribution strategy in the Small Business Health Options Program (SHOP) exchange, incorporating quality measures into exchange ratings of health plans, creation of Basic Health Plan in New Jersey, background information related to selection of an Essential Health Benefits plan, and prevention of adverse selection.^{7,8,9,10,11,12} The Center has also collaborated with Seton Hall University on a number of studies, including an assessment of the ACA’s impact on health coverage of New Jersey residents, an evaluation of federal and state regulation of rating factors, a comparison of the clearinghouse versus active purchaser model, and an investigation into eligibility and enrollment issues related to an exchange and Medicaid.^13,14,15,16Essential 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 New Jersey has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Horizon Blue Cross Blue Shield- HMO Access.

Exchange Funding

The New Jersey Department of Banking and Insurance received a federal Exchange Planning grant of $1 million in 2010. On February 22, 2012, the Department of Banking and Insurance also received a Level One Establishment grant of $7.7 million to address gaps in information technology and to continue the planning efforts and policy analysis of issues such as reinsurance, projected plan cost and utilization, standards for plan management, and the essential health benefits.¹⁷

Next Steps

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

1. A 3186/S 2135. New Jersey Health Benefit Exchange Act of 2012.http://www.njleg.state.nj.us/2012/Bills/A3500/3186_R1.PDF2. A 2171. New Jersey Health Benefit Exchange Act of 2012.http://www.njleg.state.nj.us/2012/Bills/A2500/2171_R2.PDF3. “Summary of Proceedings. Stakeholder Forum to Discuss Governance Options for a New Jersey Health Insurance Exchange.” Rutgers Center for State Health Policy. December 2011.http://www.cshp.rutgers.edu/Downloads/9160.pdf4. Cantor J, et al. “Stakeholder Views about the Design of Health Insurance Exchanges for New Jersey: Volumes I, II, and II.” Rutgers Center for State Health Policy. August 2011.http://www.cshp.rutgers.edu/Downloads/8980.pdf,http://www.cshp.rutgers.edu/Downloads/9000.pdf, http://www.cshp.rutgers.edu/Downloads/8990.pdf5. Fitzgerald B. “Countdown to NJ’s Health Insurance Exchange.” NJSpotlight. January 3, 2012.http://www.njspotlight.com/stories/12/0103/0316/6. Jacobi J. “Health Insurance Exchanges: Governance Issues for New Jersey.” Rutgers Center for State Health Policy. September 2011. http://www.cshp.rutgers.edu/Downloads/9020.pdf7. Cantor J. “Combining New Jersey’s Individual and Small Group Health Insurance Risk Pools. Rutgers Center for State Health Policy. December 2011.http://www.cshp.rutgers.edu/Downloads/9140.pdf8. Chou J, et al. “Examining a Defined Contribution Strategy in the SHOP Exchange.” Rutgers Center for State Health Policy. December 2011. http://www.cshp.rutgers.edu/Downloads/9130.pdf9. Michael M and Gaboda D. “Incorporating Quality Measures in Health Insurance Exchange Ratings of Health Plans. Rutgers Center for State Health Policy. December 2011.http://www.cshp.rutgers.edu/Downloads/9150.pdf10. Gaboda D and Farnham J. “The Basic Health Plan Option in New Jersey.” Rutgers Center for State Health Policy. December 2011. http://www.cshp.rutgers.edu/Downloads/9120.pdf11. Greenwood K, Ragone TA, Jacobi JV. “Implementing the Essential Health Benefits Requirements in New Jersey; Decision Points and Policy Issues.” Rutgers’ Center for State Health Policy and Seton Hall’s Center for Health and Pharmaceutical law and Policy. August 2012.http://www.cshp.rutgers.edu/Downloads/9540.pdf12. Canto J “Preventing Adverse Risk Selection in New Jersey’s Health Insurance Exchange and the Outside Individual and Small-Group Markets.” Rutgers Center for State Health Policy. August 2012. http://www.cshp.rutgers.edu/Downloads/9510.pdf13. Cantor J, et al. “Health Insurance Status in New Jersey after Implementation of the Affordable Care Act.” Rutgers’ Center for State Health Policy and Seton Hall’s Center for Health and Pharmaceutical law and Policy. August 2011. http://www.cshp.rutgers.edu/Downloads/8970.pdf14. Ragone TA. “Evaluating Federal and New Jersey Regulation of Rating Factors and Rating Bands. Rutgers’ Center for State Health Policy and Seton Hall’s Center for Health and Pharmaceutical law and Policy. August 2012. http://www.cshp.rutgers.edu/Downloads/9490.pdf15. Jacobi J. “Active or Passive: The Role of a New Jersey Health Insurance Exchange.” Rutgers’ Center for State Health Policy and Seton Hall’s Center for Health and Pharmaceutical law and Policy. August 2012. http://www.cshp.rutgers.edu/Downloads/9530.pdf16. Greenwood K. “The Health Insurance Exchange, the Medicaid program, and the Apportionment of Responsibility for Determining Eligibility and Effectuating Enrollment in New Jersey.” Rutgers’ Center for State Health Policy and Seton Hall’s Center for Health and Pharmaceutical law and Policy. August 2012. http://www.cshp.rutgers.edu/Downloads/9500.pdf17. U.S. Department of Health and Human Services Factsheet. “Creating a New Competitive Marketplace: Health Insurance Exchange Establishment Grants Awards List.” (Accessed February 22, 2012) http://www.healthcare.gov/news/factsheets/2011/05/exchanges05232011a.html

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

Establishing the Exchange 

On November 19, 2012, Governor Mary Fallin (R) announced that Oklahoma would not pursue the creation of a state-based health insurance exchange.¹

Prior to the announcement, Oklahoma had established the Joint Committee on Federal Health Care Law to explore the state’s options regarding federal health reform, including exchange implementation in the state.² The Joint Committee convened in 2011 and released final exchange recommendations to the Governor and the Legislature in late February 2012.^3,4 Committee recommendations included establishing a state-based private marketplace network to avoid federal involvement in the state; this would resemble a Utah model for small-businesses but would not include an individual exchange. A bill based on these recommendations was introduced in the 2012 legislative session (SB 1629) but failed at the end of the legislative session.⁵

The Oklahoma Health Insurance Exchange Project, led by the Secretary of Health as liaison to the Governor’s Office and State Legislature, the Oklahoma Department of Mental Health and Substance Abuse Services, the Insurance Department, and the Oklahoma Health Care Authority, began planning efforts in early 2011; however, the Project suspended activities in 2012 due to the exhaustion of federal grant funds.

On April 4, 2011, Governor Fallin signed into law a measure prohibiting any health insurance plans offered in the exchange from covering abortions except in cases of rape, incest, or life endangerment of the pregnant woman (SB 547).⁶ The bill allows health plan enrollees the option to purchase additional abortion coverage if desired.

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 Oklahoma 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 Oklahoma- BlueOptions PPO.

Exchange Funding

Oklahoma’s Department of Mental Health and Substance Abuse Services received a $1 million federal Exchange Planning grant. In addition, the Oklahoma Health Care Authority received a $54.5 million Early Innovator grant to develop model technological infrastructure for a health insurance exchange.⁷ In April 2011, Governor Fallin announced that Oklahoma planned to return the Early Innovator grant funding.⁸

Next Steps

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

For more information on Oklahoma’s health insurance exchange planning, visit: http://www.okhealthcare.info/

1. Press Release Governor Mary Fallin. Oklahoma will not pursue a state-based Exchange or Medicaid Expansion. November 19, 2012.http://www.ok.gov/triton/modules/newsroom/newsroom_article.php?id=223&article_id=97502. Press release. Health Care Law to be Studied over Interim. May 18, 2011.http://www.okhouse.gov/OkhouseMedia/ShowStory.aspx?MediaNewsID=40003. Summary of the Meetings of the Joint Committee on Federal Health Care Law. September 14, 2011- November 3, 2011.http://garystanislawski.net/okhealthcare.info/Presentations/Joint%20Comm%20Fed%20Health%20Care%20Laws%20summ.pdf4. Final Report of the Joint Committee of Federal Health Care Law. Oklahoma Legislature. February 22, 2012.http://www.tulsaworld.com/webextra/content/items/FINAL%20Joint%20Committee%20on%20Federal%20Health%20Care%20Law%20Report.pdf5. SB 1629. 2012 Regular Session. http://www.ok.gov/redirect.php?link_id=3326. Senate Bill 547. Approved by Governor April 20, 2011.http://www.oklegislature.gov/BillInfo.aspx?Bill=sb5477. Early Innovator Grant Awards. HHS announcement. February 16, 2011.http://www.healthcare.gov/news/factsheets/exchanges02162011a.html (Accessed August 23, 2011)8. Politico. ‘Oklahoma governor returns $54M health care grant.’ April 14, 2011.http://www.politico.com/news/stories/0411/53216.html

Final update made on December 11, 2012 (no further updates will be made)

Establishing the Exchange

On November 16, 2012, Governor Nathan Deal (R) announced that the Georgia had stopped planning for an exchange.¹ In the previous year Governor Deal issued an Executive Order to create the Georgia Health Exchange Advisory Committee to assess whether and how Georgia should establish a health benefit exchange.² The 25-member Committee included state officials, insurers, brokers, business representatives, consumers, and providers.³ The Committee also formed subgroups to develop recommendations on governance, operations and finance, and insurance markets. In October 2011, the subgroups released reports that included recommendations to establish a ‘Georgia Health Insurance Marketplace Authority’ as a quasi-governmental, non-profit corporation with a single governing body that maintains two separate risk pools for businesses and individual consumers.^4,5,6 In December 2011, the Committee submitted final recommendations to the Governor in support of creating a small business health insurance marketplace through a wholly private or limited quasi-governmental entity, but did not commit to building an individual exchange.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 Georgia did 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 Georgia- HMO Urgent Care 60 Copay.

Exchange Funding

The Georgia State Office of Planning and Budget received a federal Exchange Planning grant of $1 million in 2010.

Next Steps

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

1. Press release from Governor Nathan Deal. “Georgia Will Not Set Up Exchange.” November 16, 2012.http://gov.georgia.gov/press-releases/2012-11-16/deal-georgia-will-not-set-state-exchange2. Executive Order issued on June 2, 2011.http://gov.georgia.gov/vgn/images/portal/cit_1210/21/41/17217485106_02_11_01.pdf3. Georgia’s 2011 Health Insurance Exchange Advisory Committee Appointees.http://healthcarereform.georgia.gov/vgn/images/portal/cit_1210/15/45/173596255Advisory%20Committee%20Appointees%20-%20Updated%20072111.pdf4. Georgia Health Insurance Exchange Advisory Committee Governance Subcommittee Presentation. October 27, 2011.http://healthcarereform.georgia.gov/vgn/images/portal/cit_1210/42/42/178821132Governance%20Subcommittee%20Presentation.pdf5. Insurance Markets Subcommittee Report for the Georgia Health Insurance Exchange Advisory Committee. October 27, 2011.http://healthcarereform.georgia.gov/vgn/images/portal/cit_1210/42/41/178821134Insurance%20Markets%20Subcommittee%20Report.pdf6. Health Insurance Exchange Advisory Committee Operations and Finance Subcommittee. October 27, 2011.http://healthcarereform.georgia.gov/vgn/images/portal/cit_1210/42/40/178821136Operations%20%20Finance%20Subcommittee%20Report.pdf7. Report to the Governor. Georgia Health Insurance Exchange Advisory Committee. December 15, 2011.http://healthcarereform.georgia.gov/vgn/images/portal/cit_1210/28/4/179765813GHIX%20Final%20Report%20to%20the%20Governor.pdf