HealthReformGPS is made possible through generous financial support from the RCHN Community Health Foundation. Visit them at

Obama administration makes resources available to help states implement Exchanges

Posted on June 29, 2012 | No Comments

PDF Version
Key Developments
Implementation Briefs

U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced today a new funding opportunity to help states continue to implement the Affordable Care Act (ACA). When the ACA is full implemented in 2014, the Exchanges will provide individuals and small businesses with a one-stop shop to find, compare, and purchase quality, affordable health insurance. HHS also issued further guidance today to help states understand the full scope of activities that can be funded under the available grants.

The funding opportunity announced today will provide states with 10 additional opportunities to apply for funding to establish a state-based exchange, state partnership exchange, or to prepare state systems for a federally facilitated exchange. To date, 34 states and the District of Columbia have received approximately $850 million in Exchange Establishment Level One and Level Two cooperative agreements to fund their progress toward building exchanges.

No Comments

Public comments are closed.

In a letter addressed to the governor of Utah, Center for Consumer Information and Insurance Oversight (CCIIO) Director Gary Cohen stated that CCIIO will release updated regulations that will permit Utah to operate their small business health option program (SHOP) while the federal government runs the individual Exchange. The letter addresses how Utah and the federal government will divvy up responsibilities concerning navigators and plan management, as well as data reporting requirements for their SHOP. In addition, the letter purports that other states may also pursue a similar Exchange model.
The U.S. Department of Health and Human Services (HHS) published a final rule on the Affordable Health Insurance Exchanges (Exchanges) this morning. The publication combines policies from two Notices of Proposed Rulemaking (NPRMs) released last summer. The first outlined a proposed framework to enable states to build Exchanges and the second outlined standards for eligibility for enrollment in qualified health plans (QHPs) through the Exchange market. Starting in 2014, Exchanges will be operational...
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.
State-based health insurance Exchanges are a key component of the Patient Protection and Affordable Care Act (ACA) of 2010, facilitating expanded access to coverage for millions of individuals and employees of small businesses. The Exchanges will enable consumers to readily compare qualified health insurance options in order to select plans that best meet their needs. Premium and cost-sharing subsidies will make health coverage more affordable for low and moderate-income individuals. In this issue brief, The Henry J. Kaiser Family Foundation reviews states' progress to date in creating health insurance exchanges. While some states have already taken major steps toward establishing an exchange, other states have struggled to pass legislation or have opted not to begin the process of establishing one.
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.
This Update to the health insurance Exchange Implementation Brief examines a proposed regulation issued on August 17, 2011 as part of three proposed rules to implement provisions of the Affordable Care Act related to health insurance affordability. Companion Updates explain the proposed Medicaid eligibility rule and the proposed rule related to health insurance premium tax credits; this Update focuses on Exchange functions related to determinations of eligibility for “Exchange participation and insurance affordability programs,” as well as standards for employer participation.
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 Affordable Care Act establishes “American Health Benefit Exchanges” (serving individuals) and “SHOP” Exchanges (serving small employer groups), to be operated by states that elect to establish exchanges for individuals and employer groups through which they can buy “qualified health plans.”