Deciding whether or not to establish a state-operated Exchange is the critical first step towards the creation of an Exchange that aligns with state priorities and goals.

*Milestone details:

*Full name: Decide whether to establish an Exchange at the sub-state level, the state level, participate in a multi-state Exchange, or defer to the federal government.

*Relevance to the ACA:

The ACA requires the establishment of health benefits Exchanges. It delegates primary responsibility to the states, but requires the federal government to step in for states that opt out. Provisions relevant to establishing an Exchange include:

§1311 - Establishes the Exchanges and creates grants for states to plan and launch them.
Also creates the option for regional Exchanges and sub-state Exchanges.

§1321 - Gives the Secretary of HHS the power to establish and operate an Exchange in a state that defers or whose Exchange does not meet statutory requirements.