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    State and Partnership Exchange Policy Decisions Chart

    *Chart updated June 2013

    With the first open enrollment period less than a year away, states are beginning to ramp up their work by releasing RFPs and RFIs, holding board meetings and making decisions that will shape their exchange. This chart highlights activity around exchange policy decisions from state-based and partnership exchanges that states have shared on State Refor(u)m. If you'd like to see more about exchange governance, check out our Exchange Governance chart. For a more in-depth analysis of state QHP certification, check out our QHP chart.

    Like all State Refor(u)m research, this chart is a collaborative effort with you, the user. State Refor(u)m captures the health reform comments, documents, and links submitted by health policy thinkers and doers all over the country. And our team periodically supplements, analyzes, and compiles this key content.

    Know of something we should add to this compilation? Eager to update a fact we've included? Your feedback is central to our ongoing, real-time analytical process, so tell us in a comment, or email the author with your suggestion. She can be reached at rdolan@nashp.org.

     

    State1Exchange Financing Eligibility Systems/ Determinations SHOP ExchangePremium AggregationNavigator Program/ Consumer Assistance Active Purchasing/QHP Certification 
    AR    

    Developing an In Person Assister (IPA) program that will contract with community organizations to train and certify IPAs.  Released RFQ for IPA Guide Entity.

     Released draft QHP checklist.

    Legislation allows the board board to assess charges on qualified health plans; however, the charges cannot affect the requirement that carriers charge the same premiums inside or outside the exchange. Board brief proposes 3% on plans in the individual exchange and 4% in SHOP. QHPs outside the exchange will be assessed half that fee.

    Exchange will determine eligibility for all insurance affordability programs (IAPs) and transfer information to Medi-Cal if individual is deemed eligible.

    Legislation requires separate administration of the SHOP and individual exchanges and that the markets remain separate, with a report due in 2018 analyzing the implications of merging the markets. The state awarded a SHOP RFP to PricewaterhouseCoopers.No premium aggregation in individual exchange.The exchange is creating an Assister Program to encompass all application assistance. Navigators will be a subset of "certified enrollment assisters" that are compensated by the exchange, including groups like nonprofits, unions and clinics. They are also considering retail partnerships. Awarded outreach and education grants. Released draft regulations on assisters. Active purchasing is allowed. The exchange has also released an RFP for QHPs and developed a model contract.
    COState revenue prohibited by legislation. Legislation allows exchange to assess fees on carriers. Assessing 1.4% of exchange premiums for 2015.

    Separate systems for Medicaid/ Exchange, but shared MAGI eligibility process.

    Board has decided on combined administration, but separate risk pools.

    No premium aggregation in individual exchange.

    Navigator Role and Compensation Plan outlines scope, payment, training and oversight for navigators. Released draft of selection criteria and conflict of interest requirements for navigator entities. Also created policies for brokers operating in the exchange. Released application for the "assistance network."

    Active purchasing is prohibited by legislation.
    CTAssessment on all licensed carriers in the state. 

    Board recommended to merge administration of SHOP and individual exchange, but to keep markets separate initially.

    Business plan work group recommendations include facilitating premium collection.

    The Broker, Agent, and Navigator Advisory Committee recommends one navigator program for both the SHOP and individual exchanges and a two-tiered program focused on outreach and enrollment facilitation. Partering with the Office of the Healthcare Advocate to run navigator and IPA programs. Released RFP.

    Legislation allows Exchange to use selective criteria when certifying plans. Released QHP solicitation.

    DE 

    Will establish a rules-based eligibility engine to process applications for all programs, including Medicaid, CHIP and  the exchange.

    Conducted analysis of impact of combing two risk pools- individual premiums would increase 8% while small group premiums would decrease 6%.

     Developed certification standards for "Marketplace Assistors" as part of their partnership exchange and have released an RFP for assistors.The Health Care Commission has approved QHP Certification Standards.
    DCMarket wide premium assessment for 2015. Small group and individual markets merged. All small employers required to purchase insurance through SHOP after two years.Exchange will perform initial billing at enrollment, then pass on to carrier.

    Recommendations presented October 24, 2012 include block grants for navigators and requiring certification. Released report on role of IPAs with employer groups and board approved goals of the program, training and metrics. Released RFA for IPAs. 

    Legislation allows board to limit number of plans in Exchange using selective critieria. 

    HI2% of exchange premium assessment.

    RFP states that Exchange will consume Medicaid eligibility decisions by 2014.

    Interim board recommended combined administration through the Connector (exchange), but separate risk pools.

    Releasing RFP for study of premium aggregation  capability for individual exchange.

    Decided not to restrict navigators to non-profit entitites. Created the Hi'i Ola Program and released grant application for IPAs.

    Active purchasing is prohibited; legislation stipulates that all qualified health plans that apply must be included in exchange.

    IA 

    Indicates it will create an integrated eligibility system for premium tax credits as well as Medicaid and CHIP.

      A report by the Department of Health outlines strategies to implement a consumer outreach and education program.  
    Enacted legislation allows the exchange to assess and collect fees from participating health carriers, users and receive funds from any other source. Will assess 1.5% fee on plans sold in exchange. Exchange will interface with state's Benefit Eligibility system to provide determinations for Medicaid/CHIP and will use federal APTC/CSR determinations.  Blueprint document outlines navigator program including: eligibility, conflict of interest, and professional ethical standards as well as training and certification.The exchange will employ an "open market" model with less restrictive QHP requirements to encourage competition. Released a carrier Q&A.
    IL 

    Separate exchange and Medicaid eligibility systems being constructed.

      

     Released Outreach and Consumer Education Plan. Project narrative indicates three levels of grant-based IPA funding with performance bonuses. Working to develop state-specific IPA and navigator training.

    Released draft QHP guidelines. Additional network adequacy and quality requirements.

     Awarded a contract for a consolidated Medicaid/CHIP/exchange eligibility and enrollment system.

    Subcommittee presentation indicates the exchanges will be merged for administrative and financial reasons.

     Planning for navigator program, including identifying populations to be served and reviewing other states' programs. Released RFP for assister program. Released certification requirements for QHPs.
    MAThe Connector is authorized by legislation to deduct an administrative fee on all plan purchases and is exploring new options.

    Currently one system is used for MassHealth (Medicaid), Commonwealth Care and the Health SafetyNet. Integration Planned.

    Small employers may purchase insurance through the exchange. Individual and small group markets merged Developed selection criteria and training topics; plan to release application in March. 
    Legislation allows transaction fees in addition to broad-based assessments. Joint Committee on Exchange Financing recommends a hybrid approach with one transactional financing mechanism (broad based assessment) and one fixed, broad-based funding stream (cigarette tax). Currently receiving revenue from existing 2% market assessment.

    Developing an integrated eligibility system that will make eligibility decisions for Medicaid and Exchange.

    Legislation stipulates combined administration and separate risk pools. Developed SHOP policy recommendations, including rating and participation requirements.

    Staff recommend that the exchange perform initial billing for the individual exchange based on analysis

    Legislation creates separate navigator programs for individual and SHOP exchanges. The exchange recently released an RFI on the design of the program. Navigator policy overview includes term length, renewal and reinstatement of certifications. Released solicitation for "Connector entities" that will employ navigators and assisters as well as an RFP for a service center that will house consumer assistance activities.Legislation allows exchange to set QHP standards higher than the minimum, but must accept all plans that meet those requirements. The board has adopted final interim plan management procedures and will release a plan management manual.
     Budget for 2015 includes per member per month breakdown.Enacted legislation directs the exchange to collect up to 3.5% of premiums.

    Developing a single integrated eligibility system for Medicaid and the exchange.

     

    IT contract includes premium aggregation functionality for individual exchange.

    Released final rules on navigator/IPA training, duties, conflict of interest and payment. Released RFP for outreach and infrastructure grants and application for Consumer Assistance Partners.

    Enacted legislation allows active purchasing beginning in 2015. 

    NH    Outlined state partner functions in a consumer assistance partnership and identified existing consumer assistance resources. 
    NM

    Financial Sustainability Work Group recommendations include an assessment on carriers based on the percentage of lives they cover, devising a mechanism to assess self-insured plans and maximizing federal funding when possible. Enacted legislation allows exchange to charge assessments or fees.

    The exchange will assess eligibility for Medicaid, then refer to Medicaid for final determination. The exchange will also utilize federal determination for APTC/CSR eligibility. For 2014, the state will have a federally facilitated individual exchange.

      

    Outreach, education, adoption and enrollment committee proposes funding, certification and role for navigators as well as training and payment based on productivity. Navigators will receive Medicaid training. Program Integration Workgroup recommends training for navigators on public programs and presumptive eligibility.

     
    NVExchange will by financed by a per member/per month assessment on carriers supplemented with general fund revenues, user fees for standalone vision products, user fees for standalone dental products, and offering advertising on the web portal.Proposed fees on QHPs around $5 per member per month in 2014.

    Developing a single eligibility rules engine that will be integrated with NOMADS (Medicaid) and will also provide services to the exchange. RFP released for Eligibility Engine.

    The board voted not to merge the individual and small group markets, at least initially. 

    Yes, will aggregate premiums in the individual exchange.

    Determined roles and responsibilities of navigators, assisters and producers as well as training and certification, conflict of interest and performance metrics. Released RFA for navigators and enrollment assisters. Presentation shows overview of all customer service.

    "Free Market Facilitator" approved by board and board recently discussed certification, decertification and recertification procedures.

    NY 

    The exchange is housed in the DOH, which also performs eligibility determinations for public programs. DOH will create an integrated eligibility system for all programs including the exchange.

    Meetings with Regional Advising Committees across NY yielded a great deal of concern for the prospect of merging the individual and small markets and recommended that the state revisit the issue later. Work plan assumes state will not collect premiums on behalf of individuals. 

    The state will implement in-person assistance and Navigator programs. Both groups will provide assistance to applicants for Medicaid/CHIP and QHPs. Presentation outlines program requirements and timeline. Released RFA for navigators/IPAs. Brokers will have a large role in SHOP exchange. Compiling a list of enrollment support resources.

    Presentation outlines QHP certification process and requirements. Released an Invitation to Participate for QHPs on January 31, 2013.
    ORThe exchange is directed by legislation to establish fees on insurers and state programs ranging from 3-5% of the premium for each enrollee, depending on the total number of enrollees in the plan. Proposed fees increase from 2.68% in 2014 to 3.38% in 2015.

    Building an integrated eligibility and enrollment marketplace for tax credits and state programs such as Healthy Kids and the Oregon Health Plan.

    The exchange is conducting a study on the impact of merging the individual and small group markets.

    No. Board decided that premium aggregation was not needed in individual exchange.

    Stakeholders have requested performance-based grants. The exchange is also developing an Agent Management Program that will create a network of agents certified to sell plans in the exchange. Released customer service RFP and outreach grants RFP.

    Uniform rules for accepting plans that must apply to all carriers, rules may be more stringent than required by ACA. Released RFA for QHPs and a draft contract.

    RIThe executive order allows the exchange to receive funds from insurers and other entities, but it may not use state general revenue funds.

    Medicaid plans to transition to integrated eligibility system that will include the exchange. There will be a single integrated process from the point of application to a determination of eligibility.

       

    Exchange has discretion to choose plans beyond criteria of meeting certification requirements. 

    UTLegislation establishes an ongoing appropriation of $615,000 to the exchange.  Exchange assesses a $43 per month, per subscriber fee included in premium. Will have a federally facilitated individual exchange.The Utah Exchange currently serves small employers with 2-50 employees.   
    VTLegislation requires the Secretary of Administration to recommend a financing plan to legislative committee by January 15, 2013, and must include mechanisms for exchange funding. Report to legislature outlines expenses for 2014. 

    Vermont Integrated Eligibility and Workflow Solution (VIEWS ) will use a single, streamlined process for determining eligibility for the exchange, Medicaid, CHIP, and other public programs. Released integrated eligibility (IE) RFP.

    Legislation
    combines small group and individual markets. Small group plans must be sold through the exchange.
     Draft report outlines potential enrollees, compensation models and cost of the program. Released RFP for navigator organizations.

     

    Legislation allows exchange to contract with plans and to consider affordability, value, and other factors in the process. Released RFP for QHPs.

    WA

    Introduced legislation would tax 2% of all premiums. For 2014 utilizing portion of existing 2% market asssessment.

      Have hired a SHOP Director. SHOP implementation delayed.IT contract includes premium aggregation functionality for individual exchange. Carrier enrollment guide indicates exchange will perform billing and collections.Released draft navigator guidelines, including requirements related to trust, skills and seamlessness as well as performance measures. Released navigator/assister training requirements and an RFP.

    No active purchasing, standards same as federal legislative guidelines. The exchange has released guidance for participation in the exchange.

    WV    RFQ issued 6/14/12 for navigator program analysis.Released QHP certification guide.

    Notes

    1 State abbreviations are linked to state exchange websites, where available.

    Chart Produced by: Rachel Dolan, Sarabeth Zemel and Jade Christie-Maples

     

     

     

     

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    Comments

    I reside in Arizona, I don't show a link to State exchange website for that state?

    What is the state of Florida doing with regard to Federal Healthcare Exchanges? Also, can consumer groups apply for funding from the HHS? If so, how?
    Thanks!

    Lucius, Florida is a federal exchange state, which is why you don't see it listed on this chart only showing state-based and partnership exchanges. Consumer groups can be navigator entities, but the deadline to apply for funding to be navigators in federal exchange states was June 7. You can see the funding announcement and read more about the navigator grants here: http://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marke....

    http://oci.wi.gov/navigator/nonnavigator.htm

    In Wisconsin, to become a CAC you have to complete the federal training and in addition another 16 hours of training required by the state.

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