KFF designs, conducts and analyzes original public opinion and survey research on Americans’ attitudes, knowledge, and experiences with the health care system to help amplify the public’s voice in major national debates.
Final update made on December 12, 2012 (no further updates will be made)
Establishing the Exchange
On December 12, 2012, Governor Tom Corbett (R) notified federal officials that Pennsylvania would default to a federally-facilitated health insurance exchange.1
Prior to the announcement, the Pennsylvania Insurance Department had taken the lead with exchange planning. The Insurance Department, released an extensive report in November 2011 that suggested broad support for a state-run exchange.2 In January 2012, the Department released a conceptual draft for proposed legislation which would establish multiple private exchanges overseen by the Department.3 Consumer representatives expressed concern over the proposed model, citing such an approach would be inconsistent with the exchange requirements under the Affordable Care Act (ACA).4 In May 2012, the Department had begun soliciting for a subcontractor to provide guidance and consultation on exchange planning.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 Pennsylvania has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Aetna POS.
Exchange Funding
In September 2010, the Pennsylvania Insurance Department was awarded a $1 million federal Exchange Planning grant. In February 2012, the Department was awarded a $33.8 million federal Level One Establishment grant to continue with exchange planning and the procurement of technical expertise.6
Next Steps
The federal government will assume full responsibility for running a health insurance exchange in Pennsylvania beginning in 2014.
Final update made on December 11, 2012 (no further updates will be made)
Establishing the Exchange
On July 9, 2012, Governor Rick Perry (R) announced that Texas would not establish an exchange.1 Prior to this announcement, the Department of Insurance and the Health and Human Services Commission had partnered to explore exchange implementation plans.2 Using federal grant funding they identified subcontractors to assist with the exchange planning process, to collect stakeholder feedback, and to investigate the state’s policy options. In addition, Texas held a public exchange planning symposium and solicited public comments in early 2011.3
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. In August 2012, the Texas Department of Insurance held a public forum to discuss stakeholder feedback on the possible EHB benchmark plans.4 Texas did not put forward a recommendation and the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield of Texas- BestChoice PPO.
Exchange Funding
The Texas Department of Insurance received a federal Exchange Planning grant of $1 million in 2010, though the state has since returned $900,000 of this grant to the federal government.5
Next Steps
The federal government will assume full responsibility for running a health insurance exchange in Texas beginning in 2014.
Final update made on October 3, 2013 (no further updates will be made)
Establishing the Marketplace
On December 11, 2012, Governor C.L. Otter (R) announced Idaho’s commitment to the establishment of a State-based health insurance Marketplace and on March 28, 2013 signed into law legislation (HB248) creating the Idaho Health Insurance Exchange.12 In August 2013, the state announced that the online marketplace would be called Your Health Idaho.3
While the Governor had previously signed an Executive Order blocking the implementation of health reform in Idaho, he remained favorable towards exploring the creation of a state-run health insurance Marketplace.45 Following the Supreme Court’s decision to uphold the Affordable Care Act (ACA) in June 2012, Governor Otter stated that Idaho would work towards a market-based solution and research whether and how to implement a Marketplace. He announced the creation of new work groups to collect data on the Marketplace and Medicaid expansion.6 The Exchange workgroup was be led by the Idaho Insurance Department and representatives of key stakeholders have been appointed by the Governor including: insurers, physicians, brokers, business owners, advocacy groups, researchers and a trade association.7 In October 2012, the work group issued findings recommending the state pursue a State-based Marketplace.8
Throughout 2011, the Idaho Department of Insurance and the Department of Health and Welfare moved forward with Marketplace planning, creating the Idaho Health Insurance Exchange Project. The Exchange Project organized various work groups as well as stakeholder meetings with business owners, medical providers, insurers, Idaho Tribes, consumer advocates and the general public. The Governance work group was responsible for the initial drafting of the establishment legislation presented to the Health Care Task Force.9 The work group passed a motion in June 2011, to implement a state-run Marketplace over a federally-run one and approved seeking additional federal funding for Marketplace implementation in the state; however, the Exchange Project suspended its website in early 2012.
In April 2011, the Governor signed into law a measure prohibiting abortion coverage in the state’s health insurance exchange except in cases of life endangerment of the pregnant woman, rape or incest (SB 1115).10
Structure: The legislation defines Idaho’s Exchange as a quasi-governmental organization, specifically an “independent body corporate and politic.”
Governance: Your Health Idaho is governed by a nineteen-member board, including two non-voting ex officio members (or their designees): the Director of the Department of Insurance and the Director of the Department of Health and Welfare. The Governor appoints fourteen members of the board, the Speaker of the House appoints a member of the House of Representatives, the President pro tempore appoints a member of the Senate, and minority leadership appoints a member of the legislature representing the minority party. Members appointed by the Governor serve four-year terms. The legislation specifies that the Board should collectively offer expertise in health benefits administration, health care finance, health plan purchasing, health care delivery system administration, public health, and health policy issues related to small business and individual markets and the uninsured. A majority of the board may not collectively represent health carriers and producers.
Members of the Board, persons within the member’s household, or any entity with which the member is associated cannot benefit financially from any action taken by the Board. Members must fully disclose conflicts of interest and abstain from voting on issues in which there is a conflict of interest.
Current appointed Board members are:
Stephen Weeg, formerly of Health West
Mark Estess, AARP
Karen Vauk, Idaho Food Bank
Dave Self, Pacific Source
Scott Kreiling, Regence Blue Shield of Idaho
Zelda Geyer-Sylvia, Blue Cross of Idaho
B. Hyatt Erstad, Erstad and Co.
Tom Shores, Shores Insurance
Frank Chan, Applied Computing
Jeff Agenbroad, Since 86, Inc.
Kevin Settles, Bardenay Restaurant and Distillery
Fernando Veloz, MS Administrative Services
John Livingston, M.D.
Margaret Henbest, R.N., Idaho Alliance of Leaders in Nursing
Senator Jim Rice
Representative Kelley Packer
Representative John Rusche
The Board first met in April 2013 and established six subcommittees: information technology, finance, governance, operations, outreach and education, and the Small Business Health Options Program (SHOP) Marketplace. Also in April 2013, the Board hired an Executive Director.
Contracting with Plans: The legislation specifies that the Exchange will function as a clearinghouse; all carriers, health benefit plans, and stand-alone dental plans will be allowed to participate in the Exchange as long as they are in compliance with state and Exchange law.
In March 2013, the Department of Insurance (DOI) established a process for reviewing and accepting submissions of Qualified Health Plans (QHPs) to be sold through Your Health Idaho.11 Carriers are required to offer at least one silver and one gold plan in each market in which they want to participate. They must also offer a silver metal level plan that reflects cost-sharing reductions and two plans for Native Americans at all metal levels.12 Eight carriers were certified to offer coverage through Your Health Idaho; however, one carrier withdrew. A total of 146 plans will be offered on the Marketplace, including 61 individual plans, 55 small group plans, 13 individual dental plans, and 17 small group dental plans.13
The DOI received approval from the Centers for Medicare and Medicaid Services (CMS) to define Idaho’s geographic rating areas based on three-digit zip codes rather than the federal default. As a result, Idaho will be divided into seven geographic rating areas. Idaho’s age and tobacco rating ratios will comply with the federal default. The DOI plans to use network adequacy standards similar to the standards established by the Department of Health and Human Services for Federally-facilitated Marketplaces.14
Consumer Assistance and Outreach: In August 2013, Your Health Idaho awarded a total of $1.7 million in grants to eight In-Person Assister (IPA) organizations to provide education and enrollment assistance to consumers seeking to enroll into coverage through the Marketplace. IPAs will focus on providing education and eligibility assistance, and their services will be available at 150 locations statewide. IPAs will complete a 20 hour training course and must pass a test and a background check in order to become certified. The Marketplace intends to establish a Navigator program in 2014.15
IPAs and agents/brokers together are known as Consumer Connectors. Agents/brokers are expected to play a major role in enrolling individuals, small employers, and employees into coverage through Your Health Idaho. IPAs and call center staff are strongly encouraged to refer consumers to agents/brokers to select a plan and complete the enrollment process. Agents/brokers must complete the federal training course in order to participate on the Your Health Idaho Marketplace.
In July 2013, the state awarded a contract to develop the Marketplace’s branding, establish a communications strategy, develop educational materials, and manage media relations.16 Your Health Idaho plans to launch a $3.5 million marketing campaign, including television, radio, internet, and newspaper advertisements, in late October.17 In August 2013, the Marketplace launched a consumer-facing website, including a subsidy calculator. The website also features a Consumer Connector Locator that consumers may use to search for an IPA or an agent/broker in their zip code. In September 2013, the Your Health Idaho consumer resource center opened. Call center services are available in English and Spanish, and staff have been trained to refer consumers to an agent/broker for assistance in selecting a plan.18
Small Business Health Options Program (SHOP) Marketplace: The DOI will not merge the small group and individual markets into a single risk pool, and enrollment in the SHOP Marketplace will be limited to small employers with up to 50 employees. The Board has the authority to set a minimum participation requirement but has not yet established such a requirement.19
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. Since Idaho 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 Idaho- Preferred Blue PPO.
Marketplace Funding
The Idaho Department of Insurance received a $1 million federal Exchange Planning grant in September 2010. In November 2011, the Department of Health and Welfare, in collaboration with the Department of Insurance, received a $20.3 million federal Level One Establishment grant for the procurement and development of Marketplace and Medicaid information technology systems.20 In August 2013, Your Health Idaho applied for a $70 million Level One Establishment grant to fund Marketplace functions through 2014.21
Next Steps
On January 3, 2013, Idaho received conditional approval from the U.S Department of Health and Human Services (HHS) to establish a State-based Marketplace.22 As of October 1, 2013, individuals, families, and small businesses are able to enroll into coverage through the Marketplace; however, Your Health Idaho is using the federal government’s online eligibility and enrollment system for both the SHOP and individual Marketplaces until its IT platform is fully developed. The Your Health Idaho Marketplace IT system is expected to be operational in early 2014.23
Final update made on February 11, 2013 (no further updates will be made)
Establishing the Exchange
In October 2011, Mississippi’s elected Commissioner of Insurance Mike Chaney (R) announced that the state would establish a Health Insurance Exchange that would be operated by the Mississippi Comprehensive Health Insurance Risk Pool Association and regulated by the Insurance Department.1 However, Governor Phil Bryant (R) has opposed the effort to establish a state-based exchange.
The Comprehensive Health insurance Risk Pool Association was created by the Mississippi Legislature in 1991 to operate the state’s high risk pool, which provides coverage for people who want to purchase insurance but cannot obtain it due to health conditions. Mississippi found that the Association has legal statutory authority to operate the Exchange, subject to regulation and supervision by the Department of Insurance. On March 30, 2012, Governor Phil Bryant (R) signed SB 2589, which redefined the number and requirements for the Association’s Board of Directors.2
In a Request for Proposals (RFP) released on May 22, 2012, the Risk Pool Association described a strategy to develop and implement the Exchange exclusively using outsourced services with a multi-phased approach.3 The first phase focused on creating the web portal with shop and compare functionality, with the RFP for this task already awarded. Phase 2 focuses on Exchange functionality for unsubsidized Qualified Health Plans (QHPs), specifically the plan and premium calculation data that will enable consumers to shop, compare, and enroll in a carrier’s plan through the Exchange portal. This phase also includes marketing and outreach, navigator, call center, and other services necessary to support non-subsidized Exchange functions. Phase 3 includes most plan management, eligibility, and enrollment functionality. The selected vendor for this RFP will coordinate with the Mississippi Division of Medicaid, which continues to be responsible for eligibility determination services for Medicaid and the Children’s Health Insurance Program (CHIP). The fourth and final phase is for other supportive services and may be procured together or as a series of individual procurements. Example tasks that may be included in Phase 4 are collection and reporting of claims and encounter data; accountability and performance monitoring; and calculation, processing, and reporting of reinsurance payment and risk adjustment assignment.
Once the Exchange has been implemented, the Association would be responsible for tasks including operation of telephone hotline, maintaining the website for prospective enrollees to compare QHPs, assigning a rating to QHPs, and establishing a consumer outreach program. The Insurance Department would be responsible for plan management, including the procedure for QHP certification.
Structure: The Risk Pool Association operating the Exchange is a non-profit entity that is regulated by the Insurance Department.
Governance: The Risk Pool Association is governed by an 11-member Board of Directors. The Commissioner of Insurance appoints six members, including: two representatives of providers, one representative of businesses with fewer than 100 employees, one representative of agents, and two not associated with a medical profession, hospital, or insurer. Three members are appointed by participating insurers.4 The final two non-voting, ex officio members are the Chairs of the Senate and House Insurance Committees. The Board of Directors elects one of its members as chairman.
Separate from the Board of Directors of the Association, the Insurance Department established an Exchange Advisory Board to assist the Insurance Department in developing policy, rules, and regulations governing the Exchange.5 The Advisory Board is comprised of one member from each of the 11 Advisory Board Subcommittees, which represent the following stakeholder groups: consumers, individuals with experience facilitating enrollment in health coverage, advocates for hard-to-reach populations, small businesses and self-employed individuals, large employers, state government agencies, tribes, public health experts, providers, health insurers, and agents or brokers. Two additional Advisory Board Members were selected at-large from the Advisory Board Subcommittees and the Commissioner of Insurance (or his designee) serves as chairman of the Advisory Board.
In the first year, the Commissioner of Insurance appointed the Advisory Board members.6Beginning in 2013, the members of the Subcommittees will elect representatives to the Advisory Board. The Commissioner of Insurance will retain appointment of two at-large seats on the Advisory Board and approve the qualifications of other subcommittee applicants.
Though the Exchange Advisory Board meets quarterly, the Subcommittees meet once or twice per month depending partly on the complexity and urgency of the topic area. In addition, the Subcommittees are able to create Technical Advisory Groups to address specific issues, with the approval of the Advisory Board.7
Contracting with Plans: In November 2012, the advisory subcommittees on exchange market regulations presented initial plan management recommendations, based in part on subcontractor analyses and stakeholder interviews.8,9 The recommendations include that carriers in the small group market should be required to participate in the individual market; carriers can choose plan coverage areas but should cover the same areas inside the Exchange that they do outside the Exchange; carriers should be given flexibility to offer plans at additional metal levels and are expected offer bronze and platinum plans in response to market demand; and plans should not be subject to additional standardization beyond minimum federal requirements.
Risk Adjustment, Reinsurance, and Risk Corridors: In October 2012, a subcontractor analysis concluded that One, Mississippi should defer the risk adjustment model to the federal government initially, but develop a state-based model in subsequent years.10 The reinsurance program should be deferred to the federal government for three years as well. In November 2012, Mississippi confirmed that federal government is expected to operate both the risk adjustment and reinsurance programs.11
Consumer Assistance and Outreach: On May 23, 2012, the Insurance Department released an RFP to develop a statewide community outreach strategy and implement a campaign to inform state residents about the Exchange.12 In October 2012, the selected vendor launched an outreach campaign targeting small businesses.13 In addition, this vendor will work with another subcontractor focusing on branding and messaging. In July, the web portal went live, along with a call center provided by the website’s platform vendor. The Association and Insurance Department began soliciting participation from insurance carriers to make their plans available immediately through the portal. Vision and dental policies will be offered on this website in the future.
In June 2012, the subcommittees on outreach, education, adoption, and enrollment submitted recommendations on the Navigator Program to the Advisory Board.14 They concluded that agents and brokers should not be Navigators. Agents and brokers should be trained and certified, and receive compensation directly from the carriers and not the Exchange. Navigators should also receive comprehensive training and certification, but licensure is too restrictive. A subcontractor analysis also recommended that carriers assign One, Mississippi as their managing general agent and pay a flat fee for each plan sold.15
Small Employers Health Insurance Options Program (SHOP): The Risk Pool Association plans to establish a single, statewide exchange for both individuals and the small group market. In addition, employers with less than 50 employees will be eligible for the SHOP, until 2016 when the Exchange is required to increase the threshold to 100 employees.16The subcommittees of the Exchange Advisory Board also examined rules for employer participation, considered the value of the defined contribution model, and discussed the benefits of premium aggregation. Their recommendations were compiled and released in a single document in November 2012.17
Information Technology (IT): The Risk Pool Association laid out a four stage process to develop the Exchange’s IT infrastructure. The Risk Pool Association awarded the Phase 1 RFP for assistance in creating a health insurance web portal.18 The Association’s RFP for Phases 2 and 3 was awarded to a single vendor at the end of 2012.19 In addition, Mississippi intends to allow the federal government to perform eligibility determinations for the Advanced Premium Tax Credit (APTC) and Cost Sharing Reductions (CSR).20
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 an exchange, cover certain defined health benefits. Mississippi recommended that the Blue Cross Blue Shield Network Blue, a small group plan, be the state’s benchmark EHB plan.21
Exchange Funding
The Mississippi Department of Insurance received a federal Exchange Planning grant of $1 million in September 2010 and a federal Level One Establishment grant of $20 million in August 2011. The Establishment Grant will be used to conduct public education and outreach programs, plan the Exchange’s IT infrastructure, and continue to coordinate with other public programs such as Medicaid and CHIP.22 Former Governor Haley Barbour (R) provided a letter of support for the Level One grant application. The Insurance Department anticipates submitting an application for additional federal funds to continue Exchange implementation through 2013.23
Next Steps
Despite objections from Governor Phil Bryant (R), on November 14, 2012, Commissioner Chaney issued a declaration letter stating Mississippi’s intent to implement and operate a state-based health insurance exchange.24 To complete the Exchange blueprint, Mississippi also submitted an application to the U.S. Department of Health and Human Services (HHS), with information about the state’s plans to operate a fully state-based exchange. In late December, Governor Bryant sent a letter to HHS stating that only he has the authority to act on behalf of Mississippi to establish an exchange.25 On February 7, 2013, HHS rejected the state’s blueprint application.
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 30th 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
Final update made on November 1, 2013 (no further updates will be made)
Establishing the Marketplace
On June 18, 2012, Governor John Lynch (D) signed HB 1297 into law, which prohibits the state from participating in or enabling a state-based health insurance Marketplace. However, HB 1297 allows for state agencies or departments to “operate specific functions of a federally-facilitated exchange.”1 Given this authority, newly-elected Governor Maggie Hassan (D) informed federal officials on February 13, 2013 that New Hampshire would pursue a state-federal partnership exchange. The state will retain control over plan management and consumer assistance functions.2
In 2011, Governor Lynch allowed two bills opposing the implementation of federal health reform to become law without his signature.34 SB 148 prohibited the enforcement of the individual mandate in the Affordable Care Act and HB 601 established the Joint Health Care Reform Oversight Committee to oversee all recommendations for legislation implementing federal health reform and required the Insurance Commissioner to obtain approval from the Committee before implementing any provisions.
While Governor Lynch was initially favorable to the creation of a State-based Marketplace, opposition in the state substantially limited his ability to move forward.5 In April 2011 the Insurance Department withdrew a contract for work on Marketplace governance, eligibility, and health plan participation, because of a unanimous rejection by the Executive Council, a body of five elected members who advise and provide a check on the Governor’s power in the state.6
Contracting with Plans: The New Hampshire Insurance Department (NHID) has legislative authority to certify Qualified Health Plans (QHPs); however, standards and rules relating to QHPs are subject to approval by the Joint Health Care Reform Oversight Committee. NHID released guidelines for QHP Certification on April 10, 2013.7 Anthem Blue Cross and Blue Shield is the only insurer offering coverage in the Marketplace in 2014.8 Anthem will offer 11 health plans across three metal levels, one dental plan, and one catastrophic plan. Anthem has contracted with 16 out of 26 hospitals in New Hampshire and one hospital in Massachusetts in accordance with Network Adequacy requirements. Rates in the Marketplace are higher than other states, in part due to New Hampshire containing only one rating area and one insurer within the Marketplace.9
Risk Adjustment, Reinsurance, and Risk Corridors: In December 2012, Governor Lynch indicated that New Hampshire was interested in administering its reinsurance program; however, Governor Hassan intends to use federal services to run the state’s program.10
Consumer Assistance and Outreach: HB 1297 authorized the creation of a 12-member Health Exchange Advisory Board, for which the Governor, Insurance Commissioner, and Health and Human Services Commissioner each nominated four individuals who were all confirmed by the Executive Council. The Advisory Board, which began meeting in November 2012, is tasked with representing the interests of businesses and consumers in the Marketplace.11
Due to opposition from Republicans in the state and the failure of the legislature to appropriate funding, NHID is not able to directly oversee the implementation of consumer assistance programs, and responsibilities have been shifted to the New Hampshire Health Plan (NHHP), the state’s high risk pool. NHHP was awarded $5.3 million to fund a Marketplace Assister program and to develop and implement an outreach and education campaign.
On September 5, 2013, NHHP released a Request for Proposals (RFP) for the Marketplace Assister program. Marketplace Assisters (MPAs) will provide outreach and direct assistance to consumers seeking to enroll in coverage through the federal Marketplace, healthcare.gov. MPA proposals were due September 20, 2013 and on October 1st, NHHP announced six organizations had received funding to serve as Marketplace Assisters.12 The Marketplace Assister program will be run alongside the federal Navigator program. On August 15, 2013 CMS awarded nearly $580,000 to Planned Parenthood of Northern New England and Bi-State Primary Care Association to serve as Navigators in New Hampshire.13 NHID developed the in-person assister training curriculum and NHHP will provide program oversight. Per New Hampshire state law, Navigators and MPAs as well as other assisters may not recommend one plan over another. Insurance brokers and Agents will also play an important role in signing people up for coverage. Brokers, agents, and MPAs are required to register with CMS and the State of New Hampshire.14
Also on September 5, 2013, NHHP released an RFP for the development and implementation of an outreach and education campaign to raise awareness about the coverage opportunities under the ACA and to create a brand identity for the New Hampshire Marketplace. Components of this campaign include the development of a state-based website and a communications strategy involving television, radio, print, and online advertising; social media platforms; grassroots and small business outreach; and partnerships with community entities such as libraries, schools, and faith-based organizations. NHHP expects to award the contract in early November.15
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. New Hampshire compared potential plans and the legislative Joint Health Care Reform Oversight Committee recommended Matthew Thornton Blue (Anthem BCBS) as the benchmark plan.9 The state will use the Federal Employee Dental and Vision Plan (FEDVIP) for the pediatric dental and vision supplements.
Marketplace Funding
While the State of New Hampshire Insurance Department received a $1 million federal Exchange Planning grant, little of the money was spent. The passage of HB 601 ordered the return of $666,000 in unused funds effective July 2011 and directed the Insurance Commissioner to decline certain Marketplace planning grant funds in the future. The Department has since requested permission to use the remaining funds; however, the Executive Council declined to authorize the spending in December 2011.16In February 2013, the state was awarded a Level One Establishment grant for $894,406 to hire consultants to support plan management operations, including activity management and technical assistance, and to perform preliminary research for consumer assistance functions. In April 2013, New Hampshire received a second Level One Establishment grant totaling $5.3 million to support further planning, development, and design of a Consumer Partnership Marketplace.17 Despite being awarded this federal funding, the state of New Hampshire rejected the second level one grant funding. Instead, CMS awarded the funds to the New Hampshire Health Plan (NHHP), a quasi-government organization originally created to oversee the high risk pool. NHHP will oversee the consumer outreach and education efforts in the state.
In February 2011, New Hampshire applied for an Early Innovator grant as part of the multi-state New England consortium; however, the state itself was not included as a recipient when the award was granted.18
Next Steps
On March 7, 2013, New Hampshire received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a Partnership Marketplace.19 Enrollment in the Marketplace began October 1, 2013.
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.
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.12In 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.
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 2015.22SHOP 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.27With 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
DC Health Benefit Exchange Authority. Resolution to establish additional QHP certification standards to promote benefit standardization in the Exchange. March 13, 2013. ↩︎
DC Health Benefit Exchange Authority. Resolution to establish further EHB standards and to establish additional QHP certification standards. March 22, 2013. ↩︎
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. ↩︎
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. ↩︎
DC Health Benefit Exchange. Resolution to establish the minimum employer contribution and minimum employee participation standards within the SHOP. April 8, 2013. ↩︎
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
