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5 states and Washington, DC receive exchange grants

Posted on September 27, 2012 | No Comments

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Implementation Briefs
Key Developments

Today, the U.S. Department of Health and Human Services (HHS) announced six new health insurance exchange grant awards. The grants will go to Arkansas, Colorado, Kentucky, Massachusetts, Minnesota, and Washington, D.C. The federal support will aid the states and D.C. in creating the new exchange marketplace. D.C. received $73 million, Massachusetts $41.7 million, Arkansas $18.6 million, Minnesota $42.5 million, Colorado $43.5 million, and Kentucky $4.4 million.

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A report recently published by Price Waterhouse Cooper (PWC) examines states' progress on exchange establishment. The report found that the country, on the whole, is lagging. Only 13 states have decided to create exchanges, while eight have indicated that they will let the federal government take control of exchange establishment. The majority, the report says, are still undecided, and have until November 15 to make a final decision. The PWC report also details typical exchange participants. On average, they are 33 years old, unlikely to have a college degree, and under 200 percent of the federal poverty limit.
Health insurance exchanges form the backbone of the private insurance reforms called for in the Affordable Care Act (ACA), as they will create a marketplace in each state for small employers and individuals without job-based health insurance to buy comprehensive health coverage, with premium subsidies available for those with low or moderate incomes. As of May 2012, 13 states, together with the District of Columbia, had taken legal action to establish exchanges, through legislation or executive order. State implementing laws are essential to the translation of broad federal policies into specific state and market practices. Overall, the laws in the 14 jurisdictions vary, but they tend to show a common approach of according exchanges much flexibility in how they will operate and what standards they will apply to the insurance products sold. In all states, these "threshold policies" will be followed by policy decisions, expressed through regulations, guidelines, and health plan contracting and performance standards. A new Commonwealth Fund issue brief analyzes the choices being made by the jurisdictions to begin establishing exchanges.
California, Colorado, and Maryland were among the first states to enact legislation establishing health insurance exchanges under the Affordable Care Act (ACA). The Commonwealth Fund recently published a brief outlining differences in the states’ initial approaches: the numbers and types of people initially appointed to the boards governing the exchanges; the role of the board relative to the state legislature; how the exchanges interact with existing insurance markets; and the involvement of stakeholders in each state. The report also reviews the decisions that these states will face going forward, including how to finance the exchanges, how to make risk-adjusted payments to insurers for people likely to have high medical expenses, and how to avoid gaps in coverage and care for people who may have changes in income.
21 State Governors wrote a letter to U.S. Department of Health and Human Services Secretary Kathleen Sebelius today, suggesting changes be made to the Affordable Care Act (ACA). Some changes that the Governors call for include giving more flexibility to States in operating Exchanges and waiving certain "costly" mandates, among others.
On May 16, 2012, the United States Department of Health and Human Services issued a Draft Blueprint for Approval of Affordable State-based Exchanges (SBEs) and State Partnership Exchanges (SPEs). HHS also issued General Guidance on Federally Facilitated Exchanges (FFEs). Together, these two documents provide additional implementation information related to the final Exchange regulations issued by HHS on March 27, 2012, (click here for the regulations) which broadly describe the structural and operational requirements for state Exchanges, specify the Exchange approval process, and provide for FFEs in states that do not elect to operate a state Exchange. The newest guidance amplifies on the approval process for both state-based Exchanges (SBEs) and state Partnership Exchanges (SPEs) as a sub-class of FFEs but with...
The Department of Health and Human Services (HHS), Center for Medicare and Medicaid Services (CMS) has issued a final rule[1] addressing two previous proposed rules: “Establishment of Exchanges and Qualified Health Plans”[2] and “Exchange Functions in the Individual Market: Eligibility Determinations and Exchange Standards for Employers.”[3] The final rule addresses 1) minimum federal standards that States must meet to establish and operate exchanges, 2) the minimum standards that health insurance issuers must meet as Qualified Health Plans (QHPs), and 3) basic standards employers must meet to participate in the Small Business Health Options Program (SHOP) Exchange. CMS indicates that certain portions of the rule will be considered interim final, and the agency will accept comments on certain sections.[4] CMS also indicates in the Preamble that additional details will be made available in future guidance and rulemaking, where appropriate. For information on the proposed rules, click here. This Update describes major changes made by CMS in the final rule.
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A major problem in the U.S. health care system is the lack of affordable health insurance options for individuals and small businesses. These groups also have no easy way to compare plans in terms of premium cost, benefits and cost sharing, provider networks, or quality of care provided. The Affordable Care Act (ACA) seeks to address these problems by making private health insurance available to qualified small businesses and individuals through health insurance Exchanges beginning January 1, 2014.
The Department of Health and Human Services announced yesterday that ten states will receive $229 million in federal grants to establish health insurance exchanges in accordance with the Affordable Care Act (ACA). HHS also issued a final rule, allowing states to request “innovation waivers” from the ACA beginning in 2017. Eligible states must demonstrate they can cover as many residents with coverage as comprehensive and as affordable as would be provided under the ACA, under a plan that would not increase the federal deficit. Under ACA, the online insurance exchanges are to be in operation in all states by 2014 to allow individuals and small businesses to buy coverage and receive federal subsidies if they are eligible. In states that do not create their own exchanges, the federal government will create exchanges, and states can partner with the federal government to perform some exchange functions. The establishment grants are intended to help states build new health insurance marketplaces. The recipients of the 10 establishment grants are...
The Department of Health and Human Services (HHS) awarded nearly $220 million in Affordable Insurance Exchange grants to 13 states (Alabama, Arizona, Delaware, Hawaii, Idaho, Iowa, Maine, Michigan, Nebraska, New Mexico, Rhode Island, Tennessee, and Vermont) to booster Exchange creation. The grants will provide the states with more flexibility and resources to implement the Exchange provisions under the Affordable Care Act (ACA). To date, forty-nine states and the District of Columbia have received planning grants, and 45 states have consulted with consumer advocates and insurance companies. Thirteen states have passed legislation to create an Exchange. The Department also released several new Frequently Asked Questions, which provide information states may need as they begin creating the Exchange marketplaces. Critical among this new information is that states that run Exchanges have more options than originally proposed regarding eligibility determination for tax credits and Medicaid. States also have more time to apply for "Level One" Exchange grants. To read more about the Exchanges, click here.