Health Insurance Exchanges or Marketplaces: State Profiles and Actions

 
Health Insurance Exchanges or Marketplaces: State Profiles and Actions
Health Insurance Exchanges or Marketplaces: State Profiles and Actions
                                                          Includes information for 2015 enrollment
                                                                                As of March, 2015

This report provides the state legislative history for all states, including the 14 states and D.C. that now fully operate state-run Exchanges or
Marketplaces, the three states with state-run authority while using healthcare.gov, three that run the small-business (SHOP) exchange only, and the
state executive and legislative decisions in the 34 states that have State-Federal Partnerships (seven states), transition plans or Federally-Facilitated
Marketplaces, including reliance on healthcare.gov. The federal Affordable Care Act (ACA) permits any state to change its structure and
administration, by requesting approval from HHS.

State profiles include links and updates to all structures from State-Run to Federally-Facilitated Marketplaces and examples of implementation steps.

This report in table format is a supplement to NCSL's online report,
State Actions to Address Health Insurance Exchanges, (includes 50-state map) at www.ncsl.org/default.aspx?Tabid=21388

2015 Open enrollment for all 50 states and D.C. began Nov. 15, 2014 for three months, ending Feb. 15.
      A special extension period runs from Mar. 15, 2015 through Apr. 30 for anyone who was not fully aware of the penalties for not obtaining
health coverage for 2015. See details of consumer plan choices and a new preview “see plans” feature on Healthcare.gov for viewing premium
prices, subsidies and choices without making a binding selection.
 Individual consumers can obtain information and enroll online at: www.healthcare.gov (limited open enrollment extended to Apr. 30, 2015)
 Small employers can obtain information and enroll online at https://www.healthcare.gov/see-plans/small-business/ (also open Nov. 15, 2014)

DEFINITIONS AND ABBREVIATIONS
ACA = The federal Patient Protection and Affordable Care Act (PPACA), also termed the Affordable Care Act and sometimes referred to as “Obamacare.”
APTC = Advance Premium Tax Credit. The premium tax credit is money that the federal government pays directly to an insurance company every month so that
enrollees have lower monthly premiums. Each tax credit is based on the income the people in each tax household expect to have during the year.
BCBS = BlueCross/ Blue Shield, a commercial insurer network
CMS = The Centers for Medicare and Medicaid Services, the umbrella federal agency within HHS responsible for oversight and implementation of Marketplaces,
insurance reforms and Medicaid changes included in the ACA.
Exchange or Marketplace = The term “Exchange” is defined and used in the federal ACA statute. “Marketplace” is intended and defined in federal regulations to
have an identical meaning. The words are used interchangeably in many documents, articles and reports.
HHS = U.S. Department of Health and Human Services.
MSP = Multi-State Plan(s). MSPs are offered through Health Marketplaces/Exchanges alongside state-specific health insurer policies.
QHP = Qualified Health Plan, a health insurance product that meets the requirements of the ACA.
SHOP = Small Business Health Options Program, with insurance available to employers with up to 50 FTEs. See SHOP explanation at HealthCare.gov.
* Individual state information will be added on a regular basis, with date notations where applicable.
Health Insurance Exchanges or Marketplaces: State Profiles and Actions
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange           State Decisions/ Structure/ Background 1                Premium            Addressed                          Total Federal Funding
Information                                                                Information        Navigator/Assister                 (2010-2014) 6
by State
Alabama            On Nov. 13, 2012, Governor Robert Bentley               2015 premiums,     Navigators in the state must       $9,772,451 total federal grants
                   announced that the state will not pursue a state        Healthcare.gov     meet CMS training                  related to exchanges awarded
                   exchange.                                                                  requirements (30 hours of          to the state.
Federally
                                                                           Enrollment         training and web certification).
Facilitated        Governor Bentley created Executive Order 17 on                             Click here to view final
Marketplace                                                                Profile 4/19/14                                          $1,180,312 Planning Grant
                   June 2, 2011 to establish the Alabama Health            Alabama            navigator rule.                       $8,592,139 Level One
in Alabama         Insurance Exchange Study Commission. The                                                                          Establishment Grant
                   Commission is to study the establishment of the                            Five organizations in the state
                   Alabama Health Benefits Exchange and make               HHS report         received navigator grant funds
                   recommendations to the Governor and Legislature by      summarizing 2014   from HHS.
                   Dec. 1, 2011. These recommendations were to             plan choices and
                   include the form, governance, resource allocation,      premiums,
                                                                           9/25/2013
                   function and potential effects of the Exchange.
                   Legislation in the 2012 Session considered these
                   recommendations with regards an Alabama
                                                      3
                   Exchange, but were not passed.

Implementation Facts, Notes and News                                       2015 Insurers: Individual Market

                                                           7
   State Allowing Renewals in 2014 w/o ACA Compliance - Governor’s         Blue Cross and Blue Shield of Alabama (7 plans)
   Press Release                                                           Humana, Inc. (4)
                                                                                                 -2015
Dept of Insurance requirements:                                            UnitedHealthcare (10)
 QHP Issuer must: Be licensed and in good standing with the State;
   Be accredited by either NCQA or URAC; Cannot employ                     Small Group
   discriminatory cost-sharing designs.
                                                                           Blue Cross and Blue Shield of Alabama (6)
 Must implement and report on quality improvement strategies
   consistent with section 1311(g) of the ACA.
 Must offer (1) at least one QHP in the silver and gold coverage level;
   (2) a child-only plan at the same level of coverage; and (3) QHPs at
   the same premium rate when the QHP is offered directly by the
   issuer or through an agent or broker.
 State is not using employee choice of insurers in SHOP for 2015
 AL state attorney general has co-filed an amicus brief in the U.S.
   Supreme Court case King v. Burwell, supporting the position that
   federally-facilitated marketplace (FFM) subsidies are not legal; a
   decision is due June 2015.
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange          State Decisions/ Structure/ Background 1              Premium                 Addressed                          Total Federal Funding
Information                                                             Information             Navigator/Assister                 (2010-2014) 6
by State
Alaska            In July 2012, Governor Sean Parnell announced that    2015 premiums,          Navigators in the state must       The state has not applied for or
                  Alaska will not create a state-run health insurance   Healthcare.gov          meet CMS training                  accepted any federal funds
                  exchange under the new federal health care law. His                           requirements (30 hours of          related to health insurance
Federally
                  announcement came after the State of Alaska           Enrollment Profile      training and web certification).   exchanges.
Facilitated       completed a study on health insurance exchange                                Click here to view final
Marketplace                                                             4/19/14
                  planning.                                             Alaska                  navigator rule.
in Alaska
                                                                                                Two organizations in the state
                                                                                                received navigator grant funds
                                                                                                from HHS.

Implementation Facts, Notes and News                                    2015 Insurers: Individual Market
 Not Allowing Renewals in 2014 w/o Compliance Bulletin
                                                 7-
                                                                        Moda Health (10 plans)
 2014 ACA Insurance Reforms are in State Law = Yes
                                                       8
                                                                        Premera Blue Cross Blue Shield of Alaska (18)
 State is not using employee choice of insurers in SHOP for 2015
                                                                        Small Group –n/a
                                                                                             -2014-15
                                                                        Moda Health (40)
                                                                                                                      -
                                                                        Premera Blue Cross Blue Shield of Alaska (12)
                                                                        2014-15

                                                                        MSP
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange          State Decisions/ Structure/ Background 1              Premium               Addressed                          Total Federal Funding
Information                                                             Information           Navigator/Assister                 (2010-2014) 6
by State
Arizona           On November 28, 2012, Governor Jan Brewer             2015 premiums,        Navigators in the state must       $30,877,097 total federal grants
                  announced that the state will not establish a state   Healthcare.gov        meet CMS training                  related to exchanges awarded
                  exchange.                                                                   requirements (30 hours of          to the state.
Federally
                                                                        Enrollment            training and web certification).
Facilitated       Previously, Governor Brewer established the Office                          Click here to view final
Marketplace                                                             Profile 4/19/14                                             $999,670 Planning Grant
                  of Health Insurance Exchanges to organize the         Arizona               navigator rule.                       $29,877,427 Level One
in Arizona        state's implementation efforts and conduct analysis                                                                Establishment Grant
                  on the establishment of an exchange in the state.     ------                Four organizations in the state
                                                                                              received navigator grant funds
                                                                        HHS report            from HHS.
                                                                        summarizing 2014
                                                                        health plan choices
                                                                        and premiums,
                                                                        9/25/2013
Implementation Facts, Notes and News                                    2015 Insurers: Individual Market

                                                         8
    2014 ACA Insurance Reforms are in State Law = Yes                   Aetna Inc.
                                                                                                 -2015

                                                       7-
    Not Allowing Renewals in 2014 w/o Compliance Release Nov. 2013      All Savers Insurance Co.
   State is not using employee choice of insurers in SHOP for 2015     Blue Cross Blue Shield of Arizona,
   AZ ACA Consumer Information                                         Cigna Corp.
   Doctor/hospital and prescriptions covered by 2014 Marketplace-      Health Choice Insurance Co.,
    approved plans - AZ Dept. of Insurance [off-line 12/29/13]          Health Net, Inc., Humana, University of Arizona
                                                                        Health Plan.
                                                                        Meritus Health Partners (COOP),
                                                                                                   -2015
                                                                        Phoenix Health Plans, Inc.
                                                                                                            -2015
                                                                        Time Insurance Co./Assurant Health
                                                                        Small Group
                                                                        Blue Cross Blue Shield of Arizona
                                                                                              2014
                                                                        Health Net of Arizona
                                                                                                 2014
                                                                        Meritus Health Partners
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange            State Decisions/ Structure/ Background 1                     Premium              Addressed                           Total Federal Funding
Information                                                                      Information          Navigator/Assister                  (2010-2014) 6
by State
Arkansas            Arkansas was the first state to announce that it would       2015 Health plan     Navigators in the state must        $57,947,000 total federal grants
                    have a state/federal partnership exchange. The state         premium rates        meet CMS training                   related to exchanges awarded
                    will run both the plan management and consumer               ---------            requirements (30 hours of           to the state.
Arkansas
                    assistance functions of the exchange.                                             training and web certification).     $1,000,000 Planning Grant
Health                                                                           2014 Qualified       Click here to view final             $200,928 Planning Grant
Connector           During the 2013 legislative session, Arkansas                Health Plan          navigator rule.                          Supplement
(State-Federal      enacted HB 1508 which establishes the Arkansas               Individual                                                $7,665,483 1 Level One
                                                                                                                                                           st
Partnership         Health Insurance Marketplace, a fully state-run              Premium Rates        Two organizations in the state           Establishment Grant
Exchange)           exchange, as a non-profit entity in the state, effective     for 71 plans.        received navigator grant funds       $18,595,072 2 Level One
                                                                                                                                                              nd

                    July 1, 2015. It is responsible for setting certification                         from HHS.                                Establishment Grant
(As of 2016         standards for qualified health plans. Establishes the        Enrollment Profile                                        $16,470,852 3 Level One
                                                                                                                                                              rd

SHOP will be        Arkansas Health Insurance Marketplace Legislative            4/19/14              In addition, the state enacted           Establishment Grant
State-run;          Oversight Committee.                                          Arkansas            SB 1189 which requires               $10,641,403 4 Level One
                                                                                                                                                              th
                    In 2014 the Arkansas health exchange board voted                                  navigators to be licensed and            Establishment Grant, 10/14
in 2017 the
                    to delay until plan year 2017 the launch of its own                               certified by the state. Provides     $3,576,093 5 Level One
                                                                                                                                                           th
Individual          state-run exchange for individual coverage.                                       standards and guidelines for
market also                                                                                                                                    Establishment Grant
                    It will operate a state-run SHOP for 2016.                                        licensing and does not allow
will be State-                                                                                        insurers or insurer affiliates to
run)                #2-2014: Requirements for Assisting Consumers on the                              serve as navigators.
                    Marketplace in Arkansas
                    #1-2014: Requirement to Provide Additional Language to
                    be Included With the Delivery of Their Individual Policies

Implementation Facts, Notes and News                                             2015 Insurers: Individual Market

                                                        7                                                                       Official state logo:
    Not Allowing Renewals in 2014 w/o Compliance - Statement                     Ambetter of Arkansas (Celtic)
   Arkansas Insurance Dept. (AID) Requires: All QHP issuers                     Arkansas Blue Cross Blue Shield
    offering a plan which has pediatric dental imbedded to also offer an         National Blue Cross Blue Shield Multi-
    identical plan which does not include pediatric dental.                      state Plan
                                                                                                       -2015
   In future years, AID may limit the number of plans or benefit designs        QCA Health Plan, Inc.
    that may be offered by a carrier per "metal tier" on the Marketplace.        QualChoice of Arkansas
   Any QHP issuer that fails to achieve at least 10% Essential
    Community Provider participation will undergo a stricter review of its       Small Group Market
    issuer application.                                                          Arkansas Blue Cross Blue Shield
   AID will not impose network adequacy standards that exceed federal
    standards in the first year, but may thereafter at its discretion.           MSP
   Formulary review: issuers must provide prior authorization response          National Blue Cross Blue Shield Multi-
    within 72 hours, and must provide at least a 72-hr. supply in an             state Plan
    emergency situation
   Tobacco use rating limited to 1.2:1 (vs. the federal 1.5:1)
   State has authorized employee choice of insurers in SHOP for 2015
Update 11/12/2014
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange            State Decisions/ Structure/ Background 1                       Premium               Addressed                        Total Federal Funding
Information                                                                        Information           Navigator/Assister               (2010-2014) 6
by State
California          2010 SB 900 and AB 1602                                        2015 California       2010 state law allows the use    $1,065,686,056 total federal
                    California was the first state to establish a state-           plans and             of navigators; the board is      grants related to exchanges
                    based exchange under the ACA.                                  premiums-             responsible for defining rules   awarded to the state.
Covered
                                                                                   11/12/2014            on navigator participation. In
California                                                                                               person assisters in the state
(State-Run              The exchange is an independent state agency                                                                         $1,000,000 Planning Grant
                         with a five-member governing board.                                             need to complete two days of     
                                                                                                                                                           st
                                                                                                                                              $39,421,383 1 Level One
Exchange)                                                                                                training.
                        Allows a financial assessment to insurers for             Click here to see                                          Establishment Grant
                                                                                                                                          
                                                                                                                                                              nd
                         exchange support after Jan. 2014.                         rate filings in                                            $196,479,629 2 Level
                        Conflict of Interest: Members of the board cannot         California 2014.                                           One Establishment Grant
                         be affiliated with any entity involved in                                                                           $673,705,358 Level Two
                         the exchange (carriers, brokers, providers,                                                                          Establishment Grant
                                                                                   Enrollment
                         etc) or benefit financially from the exchange
                                                                                   Profile 4/19/14                                           $155,076,686 Level Two
                         while serving on the board.                                                                                          Establishment Grant
                                                                                   California
                        SHOP and individual exchange are separate, but                                                                       Supplement, Jan. 2014
                         board has the authority to reevaluate that in
                         2018.                                                                                                            The general fund is allowing a
                    
                                                4
                         Selection of carriers: The exchange selects                                                                      $5 million loan to establish the
                         plans that will participate in the exchange.                                                                     exchange.

Implementation Facts, Notes and News                                               2015 Insurers: Individual Market                       Official state logo:
 Not Allowing Renewals in 2014 w/o Compliance - Insurance Dept.
                                                       7

  Statement & Exchange Statement                                                   Anthem Blue Cross of California (Wellpoint)
 2014 ACA Insurance Reforms are in State Law = Yes, in part
                                                                         8         Blue Shield of California
                                                                                   Chinese Community Health Plan
 Covered California Reports –updated regularly (accessed Nov. 2014)               Health Net
 California was one of the first states, in Feb. 2015, to extend the open         Kaiser Permanente
   enrollment period for an extra week to assist residents who were not aware of   L.A. Care Health Plan
                                                                                                           2014
   the penalty requirements and deadlines.                                                            2014
                                                                                   Molina Healthcare
                                                                                                      2014
                                                                                   Sharp Health Plan
                                                                                   Valley Health Plan
                                                                                                                2014
                                                                                   Western Health Advantage

                                                                                   Small Group /SHOP – (Plans offered, 10/20/2014)
                                                                                   Plan benefits compared.
                                                                                   Blue Shield of California
                                                                                   Chinese Community Health Plan
                                                                                   Health Net
                                                                                   Kaiser Permanente
                                                                                   Sharp Health Plan
                                                                                   Western Health Advantage
Updated 3/2/2015
                                                                                   MSP
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange            State Decisions/ Structure/ Background 1                  Premium              Addressed                          Total Federal Funding
Information                                                                   Information          Navigator/Assister                 (2010-2014) 6
by State
Colorado            2011 SB 200, Chapter No. 246 -                            2015 Individual      Navigators must complete           $178,931,023 total federal
                    Bi-Partisan legislation creating a state-run exchange     plans, average       training and pass an               grants related to exchanges
                    enacted in 2011.                                          increase = 0.71%     assessment. Click here to see      awarded to the state.
Connect for                                                                   Small group plans,   a list of navigator and assistor
Health                                                                        average increase =   programs and sites throughout
Colorado               Non-profit entity governed by a 12 member             2.54%                                                      $1,247,599 Planning Grant
                        board.                                                                     the state.                            $17,951,000 First Level
(State-Run
                       Selection of carriers: The Colorado exchange          2015 Rate analysis                                          One Establishment Grant
Exchange)               allows all qualified health plans to participate in   (NORC survey)                                              $43,486,747 Second Level
                                        4
                        the exchange.                                                                                                     One Establishment Grant
                       Allows a financial assessment to insurers for         2014: Click here                                           $116,245,677 Level Two
                        exchange support after Jan. 2014.                     to view Colorado                                            Establishment Grant
                       The bill also creates the Legislative Health          rate filings
                        Benefit Exchange Implementation Review
                        Committee.
                                                                              Enrollment
                       Conflict of Interest: Members of the board may        Profile 4/19/14
                        not make decisions that benefit them financially.     Colorado
                       SHOP and Individual Exchange are two separate
                        markets, but the board has the option to review
                        this and merge them if they see fit.
                       The exchange cannot use general funds in
                        establishing or operating the exchange.

Implementation Facts, Notes and News                                          2015 Insurers:                HMO Colorado                  Small Group

                                                     7
    Not Allowing Renewals in 2014 w/o Compliance - Statement                  Individual Market             Humana                        Colorado Choice Health

                                                          8                                                 Kaiser Foundation
    2014 ACA Insurance Reforms are in State Law = Yes                         List & Rates                                                Plans
   Connect for Health Colorado metrics, updated monthly (150,821             All Savers Health             New Health Ventures           Colorado Health CO-OP
    enrollments for 2014 submitted as of Nov, 2014                            insurance                     Rocky Mountain Health         Kaiser Foundation
   Division of Insurance Approves 2015 Health Insurance Rates -              Cigna Corp.                   Plans                         Rocky Mountain Health
                                                                              Colorado Choice Health        (see full list, PDF)          Plans
    20 Carriers to Offer 1,072 Plans in 2015    agency release
                                                                              Plans                         MSP
    9/22/2014
   Colorado health exchange eyes improvements for SHOP,                      Colorado Health CO-OP
    10/13/2014                                                                Denver Health Medical                                       Official state logo:
   Colorado CO-OP Built to Shake-up Health Insurance, 11/17/2014             Plan
   13 Colorado walk-in Enrollment Sites now open across the state -
    state new release,11/22/2014
   Exchange Audit Plans by Legislature – 12/9/2014
   Exchange aims to fix stalled enrollment (overview) 1/13/2015
Updated 1/13/2015
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange          State Decisions/ Structure/ Background 1                Premium              Addressed                         Total Federal Funding
Information                                                               Information          Navigator/Assister                (2010-2014) 6
by State
Connecticut       2011 SB 921, Public Act 11-53 - establishing a state-   2015 Rate analysis   The board was required to         $200,057,795 total federal
                  run exchange                                            (NORC survey)        address how they will deal with   grants related to exchanges
Access Health      Quasi-governmental entity governed by 14                                   navigators (brokers/agents).      awarded to the state.
CT (State-Run         member board.                                       The Connecticut                                         $996,850 Planning Grant
                   Selection of carriers: Limits the number of plans                                                             $6,687,933 1 Level One
                                            4                             Insurance Dep’t                                                           st
Exchange)                                                                                      Navigators are required to
                      an insurer can offer.                               released 2014        complete 40 hours of training,        Establishment Grant
                   Allows a financial assessment to insurers for         approved rates       a test, and a pass a               $2,140,867 2 Level One
                                                                                                                                                    nd

                      exchange support after Jan. 2014.                                        background check.                     Establishment Grant
                   Conflict of Interest: Does not allow any                                                                      $20,302,003 3 level One
                                                                          Enrollment                                                                   rd

                      representative of the insurance industry or         Profile 4/19/14                                            Establishment Grant
                      providers as board members.                         Connecticut                                             $1,521,500 1 Level One
                                                                                                                                                    st

                   The Exchange was to submit a plan by Jan. 1,                                                                     Establishment Grant
                      2012 on whether or not to merge the SHOP and                                                                   Supplement
                                                                                                                                  $497,741 2 Level One
                                                                                                                                                 nd
                      individual exchange, or whether the state should
                      include mandated benefits in addition to the                                                                   Establishment Grant
                      essential health benefits for qualified health                                                                 Supplement
                      plans.                                                                                                      $107,358,676 Level Two
                                                                                                                                     Establishment Grant
                                                                                                                                  $24,960,892 Level Two
                                                                                                                                     Establishment Grant
                                                                                                                                     Supplement
                                                                                                                                  Connecticut was among the
                                                                                                                                     consortia of 6 New England
                                                                                                                                     states to receive the "Early
                                                                                                                                     Innovator" cooperative
                                                                                                                                     agreement for a total
                                                                                                                                     of $35,591,333.
Implementation Facts, Notes and News                                      2015 Insurers: Individual Market                       Official state logo:
 Not Allowing Renewals in 2014 w/o Compliance - fact sheet & Ins.
                                                 7
                                                                          Anthem Health Plans (Wellpoint)
  Dept. Memo                                                              Aetna Health Plans
 CT Exchange Release [PDF]: statistics update, 11/15/2013.               ConnectiCare Benefits Inc.
                                                                          HealthyCT (COOP)
                                                                                              -2015
                                                                          United Health Group

                                                                          Small Group (SHOP)
                                                                          Anthem Health Plans
                                                                          HealthyCT (COOP)
                                                                          United Healthcare
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

 Exchange            State Decisions/ Structure/ Background 1               Premium             Addressed                          Total Federal Funding
 Information                                                                Information         Navigator/Assister                 (2010-2014) 6
 by State
 Delaware            Governor Jack Markell submitted a letter to the U.S.   2015 premiums,      Navigators in the state must       $21,258,247 total federal grants
                     Department of Health and Human Services on             Healthcare.gov      meet CMS training                  related to exchanges awarded
 Choose              November 14, 2012, indicating that the state will                          requirements (30 hours of          to the state.
                     pursue a state/federal partnership in regards to                           training and web certification).
 Health
                     exchange establishment in the state. Delaware will                         Click here to view final              $1,000,000 Planning Grant
 Delaware                                                                   Summary of plan
                     run the plan management and consumer assistance                            navigator rule.                    
                                                                                                                                                   st
                                                                                                                                       $3,400,096 1 Level One
 (State-Federal                                                             rates and
                     functions of the federally facilitated exchange.                                                                  Establishment Grant
 Partnership                                                                detailed rate
                                                                                                One organizations in the state     
                                                                                                                                                   nd
                                                                                                                                       $8,536,543 2 Level One
 Exchange)                                                                  tables for the 21
                     On December 20, 2012, Delaware received                                    received navigator grant funds         Establishment Grant
                                                                            QHP plans.
                     conditional approval from the U.S. Department of                           from HHS.
                                                                                                                                   
                                                                                                                                                   rd
                                                                                                                                       $8,321,608 3 Level One
                     Health and Human Services (HHS) to establish a
                                                 Letter                     The Sept. 25,                                              Establishment Grant
                     Partnership Marketplace.           The Choose Health
                                                                            2013 HHS report
                     Delaware Marketplace portal became operational on
                                                                            also includes
                     October 1; consumers may download a paper
                                                                            Delaware.
                     application from the website but cannot apply for
                     Marketplace or Medicaid coverage directly through
                     Delaware’s site. The federal government is operating   Enrollment
                     the online eligibility and enrollment system and       Profile 4/19/14
                                                                            Delaware
                     consumers must use the federal portal to apply for
                     coverage online.

                     The Delaware Health Care Commission within the
                     Delaware Health and Human Services serves as the
                     planning group for the state on Health Insurance
                     Exchanges.

 Implementation Facts, Notes and News                                       2015 Insurers: Individual Market                       Official State Logo:
                                                                            Aetna (acquired Coventry Health Care)
 Allowing Some Renewals in 2014 w/o Compliance, policies to 3/31/14 -
                                                                        7   Highmark Blue Cross Blue Shield of Delaware
  Release
 2014 ACA Insurance Reforms are in State Law = Yes
                                                       8                    Small Group
 State is not using employee choice of insurers in SHOP for 2015.          Highmark Blue Cross Blue Shield of Delaware
 Commissioner Stewart Announces That Non-Compliant Health Plans
  Cannot Be Extended in Delaware                                            MSP
 CMMI State Innovation Model Design
 Delaware's Health Insurance Marketplace: Update on Activity (11/2014)

 Update 11/10/2014
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange                   State Decisions/ Structure/ Background 1                              Premium            Addressed                              Total Federal Funding
Information                                                                                      Information        Navigator/Assister                     (2010-2014) 6
by State
Florida                    After the Supreme Court issued the 2012 opinion on                    2015 premiums,     Navigators in the state must           $0. The state has not applied
                           the Patient Protection and Affordable Care Act,                       Healthcare.gov     meet CMS training                      for establishment funds related
Federally                  Governor Rick Scott announced that the state will not                                    requirements (30 hours of              to health insurance exchanges.
                           implement a state health insurance exchange                           HHS released a     training and web certification).       The state returned planning
Facilitated
                           because of the potential rise in cost for health                      report on          Click here to view final               grant funds.
Marketplace                insurance premiums.                                                                      navigator rule.
in Florida                                                                                       9/25/2013

                               September 17, 2014 – Florida Health Insurers Selling             The Florida        Eight organizations in the state
                                2015 PPACA-Compliant Small Group Policies and                    Office of          received navigator grant funds
                                their SHOP Exchange Status                                       Insurance          from HHS.
                               August 4, 2014 – Insurers Release 2015 PPACA                     Regulation
                                Individual Market Health Insurance Plan Rate Data                released monthly   In addition, the state enacted
                                Compliant with Federal Regulations (includes links to            insurance          SB 1842 requires navigators to
                                examples for a family of four and a single individual)           premiums .         register with the Department of
                                                                                                                    Financial Services. The law
                                                                                                                    also sets forth requirements
                                                                                                 2014 Enrollment
                                                                                                                    for a navigator.
                                                                                                 Profile 4/19/14
                                                                                                 Florida
Implementation Facts, Notes and News                                                             2015 Insurers:            Molina Healthcare of
 Allowing Renewals in 2014 w/o Compliance – Statement
                                                               7                                                           Florida, Inc. (in 3 counties)
                                                                                                 Individual Market
 2014 ACA Insurance Reforms in State Law = No
                                                    8                                                                      Preferred Medical Plan
                                                                                                 Aetna Insurance Co.
                                                                                                                           (in 2 counties)
 State has authorized employee choice of insurers in SHOP for 2015                              Florida Blue Cross Blue
.                                                                                                Shield
        Prior to filing or signing of the ACA, the state of Florida authorized                  Centene (Ambetter /       Small Group
         and enacted its own exchange in 2008-09. It has a website and                           Sunshine State Health     Florida Blue
         consumer information, but is not intended to comply with the                            Plan)                     Florida Health Care
         federal law requirements. See description and link below.                               Cigna Health              Plan, Inc.
                                                                                                 Coventry Health Care of   Health First Health
                                                                                                 Florida (Aetna)           Plans, Inc.
    Florida Health Choices was created in response to a vastly changing health
    care environment to help individuals and small business owners in Florida make sense         Florida Health Care       UnitedHealth Group
                                                                                                                            ,
    of the complex health insurance system.                                                      Plan Inc.
                                                                                                 Health First Health
    Our Insurance Marketplace provides easy access to affordable insurance and service           Plans (in 2 counties)
    options, acting as a “one-stop-shop” for flexible options and products. You can compare      Humana Medical Plan,
    multiple products side by side, enroll in the option that best fits your needs, and access
    important information.                                                                       Inc (in 12 counties)

    If you are not sure where to shop, we can help with that
    too. This is just one way we are working to advance the
    health and well-being of Floridians by providing
    information and access to available options
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange            State Decisions/ Structure/ Background 1                            Premium            Addressed                          Total Federal Funding
Information                                                                             Information        Navigator/Assister                 (2010-2014) 6
by State
Georgia             2014 Action: HB 943 signed 4/15/2014 prohibited the                 2015 premiums,     Navigators in the state must       $1,000,000 total federal grants
                    establishment of a state-run or partnership Health                  Healthcare.gov     meet CMS training                  related to exchanges awarded
                    Exchange, or the receipt or use of any funds to                                        requirements (30 hours of          to the state.
Federally
                    support an exchange, or the use of any further state                                   training and web certification).    $1 million Planning Grant
Facilitated         role in a navigator health enrollment program                                          Click here to view final
Marketplace                                                                             2014 Enrollment
                    operated by the University of Georgia. HB 943 and                   Profile 4/19/14    navigator rule.
in Georgia          HB 990 also prohibit the expansion of the Georgia                   Georgia
                    Medicaid program in relation to the ACA.                                               In addition, HB 198 requires
                                                                                                           navigators to be licensed and
                    On Nov. 16, 2012, Governor Nathan Deal notified                     HHS report         certified by the state insurance
                    U.S. Secretary of Health and Human Services                         summarizing 2014   commissioner.
                    Kathleen Sebelius in a letter that Georgia will not set             plan choices and
                    up a state-based health insurance exchange. This                    premiums,          Two organizations in the state
                                                                                        9/25/2013
                    means that the state defaulted to a federally-                                         received navigator grant funds
                    facilitated exchange.                                                                  from HHS.

                    2011 Action: Governor Nathan Deal created an                                           2014 Action: HB 943, signed
                    Executive Order on June 2, 2011 to establish the                                       4/15/2014 prohibited the use
                    Georgia Health Insurance Exchange Advisory                                             of any further state role in a
                    Committee. The Committee reported final                                                navigator health enrollment
                    recommendations Dec., 2011. The Executive Order                                        program operated by the
                    emphasized a desire to “develop an exchange that                                       University of Georgia.
                    reflects a free market, conservative approach to
                    expanding health insurance coverage in Georgia”.
                    The Committee was composed of legislators, the Commissioner of
                    Insurance, the Commissioner of the Department of Community
                    Health, the Chief Operating Officer of the Department of Economic
                    Development, and others.
Implementation Facts, Notes and News                                                    2015 Insurers: Individual Market                      Small Group

                                                     7
    Allowing Renewals in 2014 w/o Compliance - Ins. Dept Statement                      Ambetter from Peach State Health Plan (33 plans)      Alliant Health Plans
                                                                                                                  -2015

                                                     8
    2014 ACA Insurance Reforms in State Law = No                                        Assurant Health/Time (6)                              Blue Cross Blue Shield
   State has permitted employee choice of insurers in SHOP for 2015.                   Blue Cross Blue Shield Healthcare Plan of             Healthcare Plan of Georgia (3)
   Georgia’s state attorney general has co-filed an amicus brief in the                Georgia (Anthem) (12)                                 Kaiser Permanente (12)
    U.S. Supreme Court case King v. Burwell, supporting the position that               Cigna Healthcare (6)
    federally-facilitated marketplace (FFM) subsidies are not legal; a                  Coventry Health Care of Georgia, Inc. (5)             MSP
    decision is due June 2015.                                                          Humana, Inc. (9)                                      Aetna
                                                                                        Kaiser Permanente (9)                                 Coventry
                                                                                                             -2015
                                                                                        UnitedHealthcare (9)

Updated 1/5/2015
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange          State Decisions/ Structure/ Background 1                Premium              Addressed                       Total Federal Funding
Information                                                               Information          Navigator/Assister              (2010-2014) 6
by State
Hawaii            2011 SB 1348 (Act 205) authorized a state-run           Click here to view   Navigators are required to be   $205,342,270 total federal
                  exchange                                                Hawaii’s average     certified by the exchange.      grants related to exchanges
                                                                          rates for 2014.      They must complete a test and   awarded to the state.
Hawaii Health
                     Private non-profit governed by a 15 member                               background check.
Connector
(State-Run            (interim) board.                                    2014 Enrollment                                         $1,000,000 Planning Grant
                                                                                                                              
                                                                          Profile 4/19/14                                                       st
                      All qualified health plans are allowed to                                                                    $14,440,144 1 Level One
Exchange)                                                                 Hawaii
                      participate in the exchange.                                                                                 Establishment Grant
                                                                                                                              
                                                                                                                                                nd
                      Conflict of Interest: The board will set policies                                                            $61,815,492 2 Level One
                      and determine how to handle conflict of interest.                                                            Establishment Grant
                     Interim board provided recommendations                                                                      $128,086,634 Level Two
                      regarding a funding plan (not allowed to use                                                                 Establishment Grant- 2/2013
                      state funds), conflict of interest criteria, and
                      board member terms, among other items by the
                      2012 legislative session.

Implementation Facts, Notes and News                                      2015 Insurers: Individual Market                     Official State Logo:
 Allowing Renewals in 2014 w/o Compliance - Ins. Dept. Statement
                                             7
                                                                          Hawaii Medical Service Association
 2014 ACA Insurance Reforms in State Law = No
                                                8
                                                                          Kaiser Permanente
                                                                          Small Group/SHOP
                                                                                             -2015
                                                                          Kaiser Permanente
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange            State Decisions/ Structure/ Background 1                  Premium                   Addressed                        Total Federal Funding
Information by                                                                Information               Navigator/Assister               (2010-2014) 6
State
Idaho               A state-run health insurance exchange for Idaho           Click here for a          For information regarding        $69,395,587 total federal grants
                    was authorized in March 2013 when the legislature         press release             Idaho’s Consumer                 related to exchanges awarded
Your Health         passed HB 248. The governor declared the state’s          from Your Health          Connectors, click here. [March   to the state.
                    intention to run an exchange in December 2012,            Idaho on                  2014 update]
Idaho
                    and the governor and legislative                          premium ranges.                                               $1,000,000 Planning Grant
(State-Run          leadership appointed 19 governing board members.                                                                     
                                                                                                                                                           st
Exchange                                                                                                                                     $20,376,556 1 Level One
                                                                              Full Health Plan                                               Establishment Grant
Board, using                                                                  Guide with rates                                           
                    In order to meet the exchange enrollment deadline                                                                                     nd
Healthcare.Gov                                                                                                                               $48,019,031 2 Level One
                    in October 2013, the governing board in Idaho             & benefits for                                                 Establishment Grant
with federal        requested that the federal government support             2014. [193 pp]
support             certain services, such as determining enrollment                                                                     On Feb 21, 2014, the Board
services)           eligibility, in the state exchange initially.             2014 Enrollment
                                                                                                                                         awarded $40.8 million in
                                                                              Profile 4/19/14
                                                                              Idaho
                                                                                                                                         federally funded contracts to 2
                    Although the federal government will be supporting                                                                   companies to run a state
                    most services in the Idaho exchange in 2014 plan                                                                     exchange website and
                    year, Exchange board members Senator Jim Rice                                                                        technology. The exchange is a
                    (R) and House Minority Leader John Rusche (D) did                                                                    quasi-governmental agency,
                    not expect the federal government to support the                                                                     not permitted to accept state
                    state beyond the initial open enrollment period. The                                                                 funding.
                    state is using the federal system for eligibility
                    determination, The state is also working on a
                    transitional plan with the eventual goal of eliminating                                                              The state-run exchange is
                    federal support of the state exchange’s operations.                                                                  charging a 1.5% premium fee
                                                                                                                                         (compared to the 3.5% fee in
                                                                                                                                         federally-facilitated
                                                                                                                                         marketplaces)

                                                                                                                                         [updated 3/6/2014]
Implementation Facts, Notes and News                                          2015 Insurers: Individual Market                           Official State Logo:
 Allowing Renewals in 2014 w/o Compliance - n/a -Statement |
                                               7
                                                                              Blue Cross of Idaho
                                                                                                            -2015, 2014
 Discontinuation of individual and small group health plans by Idaho         BridgeSpan Health Company
                                                                                                      -2015
  carriers explained - 11/5/2013                                              Mountain Health CO-OP
 2014 ACA Insurance Reforms in State Law = No
                                                   8                          PacificSource Health Plans
 2015 Small Group Composite Premium Proposal 6/14/2014                       SelectHealth, Inc.

                                                                              Small Group
                                                                              Blue Cross of Idaho
                                                                              PacificSource Health Plans
                                                                              SelectHealth, Inc.
                                                                              Note: Certification vote taken Sept. 22
11/15/2014
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange            State Decisions/ Structure/ Background 1                 Premium              Addressed                          Total Federal Funding
Information                                                                  Information          Navigator/Assister                 (2010-2014) 6
by State
Illinois            On Oct. 16, 2012, Illinois announced that it will work   2015 premiums,       Navigators in the state must       $154,813,136 total federal
                    with the federal government to run the exchange in       Healthcare.gov       meet CMS training                  grants related to exchanges
Illinois            the state. The state intends to transition to a fully                         requirements (30 hours of          awarded to the state.
                    state operated exchange within a year of partnership     2014 Enrollment      training and web certification).
Partnership
                    operation.                                               Profile 4/19/14      Click here to view final              $1,000,000 Planning Grant
Marketplace
                                                                                                                                     
                                                                                                                                                     st
                    In 2011, SB 1555 Public Act 97-0142 intended to          Illinois
                                                                                                  navigator rule.                        $5,128,454 1 Level One
                    establish a state based health insurance exchange.                                                                   Establishment Grant
(State-Federal      The act created an Illinois Health Benefits Exchange                          Eleven organizations in the        
                                                                                                                                                        nd
                                                                                                                                         $32,789,377 2 Level One
partnership         Legislative Study Committee to inquire further into                           state received navigator grant         Establishment Grant
for 2014-2015)      the establishment of the Illinois Health Benefits        HHS report           funds from HHS.                    
                                                                                                                                                          rd
                                                                                                                                         $115,823,521 3 Level One
                    Exchange.                                                summarizing 2014                                            Establishment Grant
(Plans for                                                                   plan choices and     In addition, SB 1194 creates
                                                                             premiums,            the Insurance Navigator
State-Run           In October 2011, the Legislative Study Committee
                                                                             9/25/2013
Exchange,           provided a report titled, Findings of the Illinois                            Licensing Act; providing that
online via          Legislative Health Insurance Exchange Study                                   no individual or entity shall
healthcare.gov)     Committee.                                                                    perform, offer to perform, or
                                                                                                  advertise any service as a
                                                                                                  navigator in the state or
                    According to the state's health reform website,
                    “Additional legislation to establish governance and                           receive navigator funding from
                                                                                                  the State or an exchange
                    financing structure of the Exchange in Illinois is
                                                                                                  unless licensed as a navigator
                    currently being assessed in the Illinois General
                                3                                                                 by the Director of Insurance;
                    Assembly."
                                                                                                  includes prohibited activities;
                                                                                                  applications for licensure;
                                                                                                  licenses renewal.
Implementation Facts, Notes and News                                         2015 Insurers: Individual Market
 Allowing Renewals in 2014 w/o Compliance = Yes - Announcement
                                                 7
                                                                             Assurant Health (6)
 2014 ACA Insurance Reforms in State Law = In Process                       Blue Cross Blue Shield of Ill.(20)
                                                           8
                                                                             Coventry Health Care (5)
 State is not using employee choice of insurers in SHOP for 2015
                                                                             Humana, Inc. (10)
 Ten Issuers Apply to Offer 504 QHP’s for 2015                              IlliniCare Health (66)
                                                                             Land of Lincoln Mutual Health Insurance Company (26)
                                                                             UnitedHealthcare (10)

                                                                             Small Group
                                                                             Blue Cross and Blue Shield of Illinois (17)
                                                                             Land of Lincoln Mutual Health Insurance Co.(26)
                                                                                                             -2014
                                                                             Health Alliance Medical Plans

                                                                             MSP
Update 11/16/2014
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange           State Decisions/ Structure/ Background 1                 Premium              Addressed                          Total Federal Funding
Information                                                                 Information          Navigator/Assister                 (2010-2014) 6
by State
Indiana            Governor Mike Pence, soon after the November             2015 premiums,       Navigators in the state must       $7,895,126 total federal grants
                   2012 election, stated that he will not support the       Healthcare.gov       meet CMS training                  related to exchanges awarded
Federally          creation of state-based or partnership exchange.                              requirements (30 hours of          to the state.
Facilitated        Former Governor Mitchell Daniels, Jr. created            2014 Enrollment      training and web certification).
                   Executive Order 11-01 to establish the Indiana           Profile 4/19/14      Click here to view final              $1,000,000 Planning Grant
Marketplace
                   Health Benefit Exchange; however the exchange            Indiana              navigator rule.                       $6,895,126 Level One
in Indiana         was not implemented and would have required                                                                          Establishment Grant
                   legislative action.                                                           Four organizations in the state
                                                                                                 received navigator grant funds
                                                                            HHS report
                                                                                                 from HHS.
                                                                            summarizing 2014
                                                                            plan choices and
                                                                            premiums,            In addition, Public Law 278
                                                                            9/25/2013            sets forth regulations and
                                                                                                 compliances for navigators.

Implementation Facts, Notes and News                                        2015 Insurers: Individual Market
                                                                                       -2015
 Not Allowing Renewals in 2014 w/o Compliance - Insurance Dept.
                                                   7
                                                                            All Savers
  Statement                                                                 Anthem BCBS
                                                                                        -2015
 State has permitted employee choice of insurers in SHOP for 2015          Caresource
                                                                                                -2015
 Indiana’s state attorney general has filed an amicus brief related to     Coordinated Care
                                                                                            -2015
  the U.S. Supreme Court case King v. Burwell, supporting the position      IU Healthplans
                                                                                                    -2015
  that federally-facilitated marketplace (FFM) subsidies are not legal; a   MDwise Marketplace
  decision is due June 2015.                                                Physicians Health Plan of Northern Indiana (regional)
                                                                            Centene Corp. (Ambetter from MHS - regional)
                                                                                                                     -2015
                                                                            Southeastern Indiana Health Organization
                                                                                           -2015
                                                                            Time/Assurant
 .
                                                                            Small Group
                                                                            Anthem Blue Cross and Blue Shield
                                                                                                       -2015
                                                                            Advantage Health Solutions
                                                                                                                     -2015
                                                                            Southeastern Indiana Health Organization

                                                                            MSP
Updated 1/5/2015
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange              State Decisions/ Structure/ Background 1                        Premium                  Addressed                            Total Federal Funding
Information                                                                           Information              Navigator/Assister                   (2010-2014) 6
by State
Iowa                  Iowa Governor Terry Branstad announced in December              2015 premiums,           Navigators in the state must meet    $59,683,889 total federal grants
                      2012 that the state would run the plan management piece         Healthcare.gov           CMS training requirements (30        related to exchanges awarded to
                      of the exchange in the state. Iowa is among the seven                                    hours of training and web            the state.
State-Federal         states that are partnering with the federal government;                                  certification). Click here to view
Partnership           however, it was the only state that has decided to run only                              final navigator rule.
                                                                                      Click here to see a                                              $1,000,000 Planning Grant
Marketplace           the plan management function and not the other optional
                      consumer assistance function for partnership states.            release of rates         Three organizations in the state                     st
                                                                                                                                                        $7,753,662 1 Level One
for Iowa                                                                              from the Iowa                                                     Establishment Grant
                                                                                                               received navigator grant funds
                      In a previous November 2012 letter to U.S. Secretary of         Insurance Division       from HHS.                                                nd
                                                                                                                                                         $26,623,003 2 Level One
                      Health and Human Services Kathleen Sebelius, Governor           for the                                                           Establishment Grant
                      Branstad said that the state will continue to pursue a state-   Marketplace.                                                                   rd
                                                                                                                                                         $6,844,913 3 Level One
                      based exchange, despite some questions and concerns                                                                               Establishment Grant
                      about the exchanges. The governor mentioned in the letter       2014 Enrollment                                                                  th
                                                                                                                                                        $17,462,311 4 Level One
                      that the state may have to default "to some level of a          Profile 4/19/14                                                   Establishment Grant
                      federally-facilitated" exchange if more guidance and            Iowa
                      additional details are not provided from the federal
                      government.

                      The Department of Health established an Interagency
                      Planning Workgroup to collaborate between the Iowa
                      Department of Public Health, Iowa Department of Human
                      Services (State Medicaid Agency), Iowa Insurance
                      Division, and the Iowa Department of Revenue. The
                      Department will create final recommendations to include:
                      organizational structure for the exchange, implementation
                      plan including policy recommendations and core
                      capabilities, sustainability plan, comprehensive plan for
                      implementation, expansion of stakeholder input, and
                      coordinate planning efforts with existing state and federal
                      programs. They will also assess needed resources and
                      regulations.
Implementation Facts, Notes and News                                                  2015 Insurers: Individual Market

                                                7
    Allowing Renewals in 2014 w/o Compliance - Iowa Insurance Div. Notice             Avera Health Plans (regional)
   2014 ACA Insurance Reforms in State Law = No
                                                 8
                                                                                      CoOpportunity Health (CO-OP; state-wide) – see
 State has permitted employee choice of insurers in SHOP for 2015                    Implementation news
   State-based CoOportunity faces financial difficulty - Iowa Insurance              Coventry Health Care of Iowa (state-wide)
    Commissioner took over operations in December, explains it will be difficult to   Gunderson Health Plan (in 5 counties)
    save the CO-OP, which provided health insurance to more than 100,000
    people in Iowa and Nebraska, amid a financial crunch. Jan. 7, 2015.               Small Group
                                                                                      Not available, as of 1/7/2015
   For 2015, Wellmark Blue Cross/Blue Shield has nearly 80% of the private
    market but does not participate in the Marketplace.

                                                                                      Insurance Dept.: http://www.iid.state.ia.us/node/6308681

Updated 1/12/2015
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange            State Decisions/ Structure/ Background 1                Premium            Addressed                          Total Federal Funding
Information                                                                 Information        Navigator/Assister                 (2010-2014) 6
by State
Kansas              On Nov. 8, 2012, Governor Sam Brownback                 2015 premiums,     Navigators in the state must       $1,000,000 total federal grants
                    announced that the state will not participate in        Healthcare.gov     meet CMS training                  related to exchanges awarded
Federally           implementing a state or partnership exchange.                              requirements (30 hours of          to the state.
                        2011 Action: Insurance Commissioner Sandy           2014 Enrollment    training and web certification).
Facilitated
                    Praeger requested a steering committee charter to       Profile 4/19/14    Click here to view final              $1,000,000 Planning Grant
Marketplace         make recommendations to the Department of                                  navigator rule.
                                                                            Kansas
in Kansas           Insurance regarding the planning and development
State sponsored     of a Kansas Health Benefit Exchange. In addition,                          Three organizations in the
portal at           eight planning workgroups comprised of citizens                            state received navigator grant
                                                                            HHS report
http://insureks.    across the state report to the steering committees on                      funds from HHS.
                                                                            summarizing 2014
org                 issues related to their specific workgroup topic. The   plan choices and
                    planning work done by the Department of Insurance       premiums,
                    is supported by the governor and workgroups             9/25/2013
                    continue to meet.

                    The state has an insurance cost calculator.

Implementation Facts, Notes and News                                        2015 Insurers: Individual Market                      Official State Logo:
 Allowing Renewals in 2014 w/o Compliance - KS Insurance Dept.
                                               7                                                                                  (information only; no sales)
                                                                            Blue Cross and Blue Shield of Kansas
  Memorandum, 12/19/2013                                                    Blue Cross and Blue Shield of Kansas City (2
 The state maintains an informational exchange website [2014]              counties)
 State is not using employee choice of insurers in SHOP for 2015
 Ins. Commissioner's column on open enrollment, November 2014              Small Group
                                                                            Blue Cross and Blue Shield of Kansas

                                                                            MSP
Update 11/15/2014
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange          State Decisions/ Structure/ Background 1                 Premium             Addressed                         Total Federal Funding
Information                                                                Information         Navigator/Assister                (2010-2014) 6
by State
Kentucky          Kentucky Governor Steve Beshear issued an                Click here to see   Navigators are required to        $253,698,351 total federal
                  Executive Order establishing the Office of the           charts from the     complete training, a test, meet   grants related to exchanges
Kynect            Kentucky Health Benefit Exchange, which will             governor’s media    performance measure and get       awarded to the state.
                  oversee the implementation and operations of the         briefing on         recertified every year.
(State-Run
                  Exchange. The office will be housed in the Cabinet       premiums.                                                $1,000,000 Planning Grant
Exchange)
                                                                                                                                 
                                                                                                                                                 st
                  for Health and Family Services. The governor made                                                                  $7,670,803 1 Level One
                  his intentions to establish an exchange clear in early   2014 Enrollment                                           Establishment Grant
                                                                                                                                 
                  May, when he stated that if the court upheld the                                                                                  nd
                                                                           Profile 4/19/14                                           $57,896,810 2 Level One
                  Patient Protection and Affordable Care Act, he           Kentucky                                                  Establishment Grant
                  preferred to take the advice of many stakeholders                                                              
                                                                                                                                                 rd
                                                                                                                                     $4,423,000 3 Level One
                  and create an exchange run by the state. The                                                                       Establishment Grant
                  exchange in the state will limit the number of plans                                                              $182,707,738 Level Two
                  that insurers can offer.                                                                                           Establishment Grant

Implementation Facts, Notes and News                                       2015 Insurers: Individual Market                      Official State Logo:
 Allowing Renewals in 2014 w/o Compliance - Governor’s Press Release
                                              7
                                                                           Anthem Health Plans of Kentucky
                                                                                      -2015
 2014 ACA Insurance Reforms in State Law = No
                                                 8                         CareSource
 Kentucky Health Cooperative Claims 75% of enrollment on the              Humana Health Plan
   State Exchange - new figures from Kynect. 3/5/2014                      Kentucky Health Cooperative
                                                                                               -2015
                                                                           WellCare of Kentucky
                                                                                                                                                           .
                                                                           Small Group
                                                                           Anthem Health Plans of Kentucky
                                                                                      -2015
                                                                           CareSource
                                                                           Kentucky Health Cooperative
                                                                           United Healthcare
                                                                                                -2015
                                                                           WellCare of Kentucky

                                                                           MSP
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange          State Decisions/ Structure/ Background 1               Premium                Addressed                               Total Federal Funding
Information                                                              Information            Navigator/Assister                      (2010-2014) 6
by State
Louisiana         In March 2011, Governor Bobby Jindal announced         2015 premiums,         Navigators in the state must            $998,416 total federal grants
                  that Louisiana would return planning grant funds and   Healthcare.gov         meet CMS training                       related to exchanges awarded
Federally         the state will not establish a state exchange.                                requirements (30 hours of               to the state.
Facilitated                                                              2014 Enrollment        training and web certification).         $998,416 Planning Grant-
                                                                         Profile 4/19/14        Click here to view final                     All funds returned
Marketplace                                                                                     navigator rule.
in Louisiana                                                             Louisiana
                                                                                                Four organizations in the state
                                                                         HHS report             received navigator grant funds
                                                                         summarizing 2014       from HHS.
                                                                         plan choices and
                                                                         premiums,
                                                                         9/25/2013
Implementation Facts, Notes and News                                     2015 Insurers: Individual Market                               Official State Logo:
 Allowing Renewals in 2014 w/o Compliance - Insurance Comm.
                                             7
                                                                         Blue Cross Blue Shield of Louisiana (19 plans)                 (information only, no sales)
  Bulletin, 11/27/2013                                                   HMO Louisiana, Inc. (14)
 2014 ACA Insurance Reforms in State Law = No
                                                   8
                                                                         Humana, Inc. (10)
 State is not using employee choice of insurers in SHOP for 2015        Louisiana Health Cooperative (CO-OP, 8)
                                                                         UnitedHealthcare (10)
                                                                         Vantage Health Plan (4)

                                                                         Small Group (2015)
                                                                         Blue Cross Blue Shield of Louisiana (2)
                                                                         Louisiana Health Cooperative (8)
                                                                         Vantage Health Plan (4)

                                                                         HHS listed HMO Louisiana, Inc. as also approved for SHOP for
                                                                         2015, 11/28/2014
                                                                         *MSP
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange         State Decisions/ Structure/ Background 1               Premium             Addressed                          Total Federal Funding
Information                                                             Information         Navigator/Assister                 (2010-2014) 6
by State
Maine            In a letter to U.S. Secretary of Health and Human      2015 premiums,      Navigators in the state must       $6,877,676 total federal grants
                 Services Kathleen Sebelius on Nov. 16, 2012,           Healthcare.gov      meet CMS training                  related to exchanges awarded
Federally        Governor Paul LePage wrote that the state will not                         requirements (30 hours of          to the state.
                 establish a state-based health insurance exchange.     2014 Enrollment     training and web certification).
Facilitated
                 In April 2012, Governor Paul LePage stated that        Profile 4/19/14     Click here to view final              $1,000,000 Planning Grant
Marketplace      Maine will not use the Level One Establishment grant                       navigator rule.
in Maine                                                                Maine                                                     $5,877,676 Level One
                 awarded to the state and that the state will not                                                                  Establishment Grant
                 establish a state-based exchange.                                          Two organizations in the state         (Governor LePage informed
                                                                                            received navigator grant funds         HHS that he would not
                                                                        HHS report          from HHS.                              utilize establishment funds)
                                                                        summarizing 2014
                                                                        plan choices and
                                                                        premiums, 9/25/14                                         Maine also was among the
                                                                                                                                   consortia of 6 New England
                                                                                                                                   states to receive the "Early
                                                                                                                                   Innovator" cooperative
                                                                                                                                   agreement, administered by
                                                                                                                                   the University of
                                                                                                                                   Massachusetts Medical
                                                                                                                                   School Award Amount:
                                                                                                                                   $35,591,333

Implementation Facts, Notes and News                                    2015 Insurers: Individual Market
 Allowing Renewals in 2014 w/o Compliance - Yes, Insurance Dept.
                                           7
                                                                        Anthem Blue Cross and Blue Shield (12 plans)
                                                                                            -2015
  Release, 11/22/2013                                                   Harvard Pilgrim (4)
 2014 ACA Insurance Reforms in State Law = Discretionary               Maine Community Health Options (9)
                       8
  authority to enforce
 State is not using employee choice of insurers in SHOP for 2015       Small Group
                                                                        Anthem Blue Cross and Blue Shield (4 plans)
                                                                        Harvard Pilgrim (4)
                                                                        Maine Community Health Options (8)

                                                                        *MSP
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange          State Decisions/ Structure/ Background 1                   Premium              Addressed                         Total Federal Funding
Information                                                                  Information          Navigator/Assister                (2010-2014) 6
by State
Maryland          State-run Exchange established by law:                     Click here to view   Navigators are required to        $171,063,110 total federal
                  2011 SB182 (Chapter 1) & 2011 HB 166 (Chapter 2)           Maryland Health      complete 120 hours of training,   grants related to exchanges
Maryland                                                                     Connections          an exam, and recertify            awarded to the state.
                         Quasi-governmental exchange governed by            Premiums for         annually.
Health
                          a nine member board.                               2014.                2012 HB 443: Requires a              $999,227 Planning Grant
Connection                                                                                        SHOP exchange navigator
(State-Run               Maryland will use a portion of an existing                                                                   $27,186,749 Level One
                          premium tax to fund the exchange after             2014 Enrollment      program.                              Establishment Grant
Exchange)                                                                    Profile 4/19/14      2013 HB 361: Establishes fees
                          2015.                                                                                                        $136,599,681 Level Two
                         The exchange limits the type or number of          Maryland             for Small Business Health             Establishment Grant
                                                                                                  Options Program (SHOP)
                          plans each insurer can offer in the exchange.                                                                Maryland received the
                                                                                                  exchange navigator licensing.
                         Conflict of Interest: Members of the board                                                                    "Early Innovator"
                          cannot be affiliated with any entity involved in                                                              cooperative agreement.
                          the exchange (carriers, brokers, providers,                                                                   Award Amount: $6,227,454
                          etc) or benefit financially from the exchange
                          while serving on the board.
                         In December 2011, the board submitted a
                          letter with structure recommendations to the
                          governor and legislature.

Implementation Facts, Notes and News                                         2015 Insurers: Individual Market                       Official State Logo
 Not Allowing Renewals in 2014 w/o Compliance - Press Release &
                                                  7
                                                                             All Savers Insurance (UnitedHealth Group)
  Bulletin                                                                   CareFirst BlueChoice Inc.
 2014 ACA Insurance Reforms are in State Law = Yes
                                                      8
                                                                             CareFirst of Maryland Inc.
 The Maryland exchange announced it will launch its SHOP in April           Evergreen Health Cooperative (CO-OP)
  2014 using brokers and agents to enroll members on paper                   (GHMSI a CareFirst company)
  applications.                                                              Kaiser Foundation Health Plan of the Mid-Atlantic
                                                                             Small Group
                                                                                   -2015
                                                                             Aetna
                                                                             All Savers Insurance (UHC subsidiary)
                                                                             CareFirst of Maryland Inc.
                                                                             Coventry Health Care of Delaware Inc.,
                                                                             Coventry (Aetna).
                                                                             Evergreen Health Cooperative (CO-OP)
                                                                             Kaiser Foundation Health Plan of the Mid-Atlantic
                                                                             MAMSI Life and Health Insurance Co.,
                                                                                              -2015
                                                                             Optimum Choice
                                                                                                 -2015
                                                                             UnitedHealth Care

                                                                             MSP
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange             State Decisions/ Structure/ Background 1                    Premium                       Addressed                            Total Federal Funding
Information                                                                      Information                   Navigator/Assister                   (2010-2014) 6
by State
Massachusetts        State-run Exchange established by law:                                                    Navigator training is                $192,953,864 total federal
                     Chapter 58 of the Acts of 2006                              2014 Enrollment               completed in phases.                 grants related to exchanges
Massachusetts                                                                    4/19/14                       Operational program                  awarded to the state.
Health               In May, 2014, the Connector board and the governor          Massachusetts                 currently has a consumer
Connector            announced a dual-track total website replacement,                                         assistance program which                $1,000,000 Planning Grant
(State-Run           using a new commercial contract design, while also                                        will be built to meet all            
                                                                                                                                                                      st
                                                                                                                                                        $11,644,938 1 Level One
Exchange,            preparing to use healthcare.gov as a fall-back for                                        exchange requirements and                Establishment Grant
                     2015.                                                                                     meet exchange needs.                 
                                                                                                                                                                      nd
                                                                                                                                                        $41,679,505 2 Level One
2014-2015)
                                                                                                                                                        Establishment Grant
                     In 2006, Massachusetts passed health reform                                                                                       $13,917,409 Level One,
                     legislation that established a state initiated exchange.                                                                           awarded 10/14/2014
                      The "Health Connector," launched in 2007,                                                                                       $80,225,650 Level Two
                          serves multiple functions and managed two                                                                                     Establishment Grant
                          health insurance programs: Commonwealth                                                                                      Massachusetts was one of
                          Care, a subsidized program for adults who do not                                                                              6 New England states to
                          have employer-sponsored insurance and                                                                                         receive the "Early
                          Commonwealth Choice offering commercial                                                                                       Innovator" cooperative
                          insurance plans for individuals ineligible for care                                                                           agreement. Administered
                          as well as small business employers. It uses an                                                                               by the University of
                                                                             4
                          “active purchaser” approach to carrier selection.                                                                             Massachusetts Medical
                      Annual Reports are provided to the Legislature.                                                                                  School. Award Amount:
                          Reports to Legislature Archive are available                                                                                  $35,591,333
                          online through the Massachusetts DHHS.
                      A $25 million appropriation from the state general
                          fund helped start the exchange. State funds are
                          appropriated annually.
Implementation Facts, Notes and News                                             2015 Insurers:                                                     Official State Logo
   As of 4/1/2014 the state has expanded, continuing “special                   Individual & Small Group Market
    enrollment periods” for residents applying for subsidized coverage           Ambetter from CeltiCare
                                                                                                                -2014+2015

    up to 300% of federal poverty.                                               Blue Cross Blue Shield of Massachusetts
                                                                                                                                       -2014+2015

                                                     7
    Not Allowing Renewals in 2014 w/o Compliance - Ins. Dept. Letter.            Boston Medical Center HealthNet Plan
                                                                                                                                   -2014+2015
   New Mass. health website estimate to cost $121 million, 5/8/2014                                                    -2014+2015
                                                                                 Fallon Community Health Plan
   Gov. Patrick announces remedial actions for website, 2/6/2014                                                    -2014+2015
   Health Care Site Official requested 6-month extension to continue            Harvard Pilgrim Health Care
                                                                                                          -2014+2015
    subsidized care program and stop-gap coverage – 2/12/2014                    Health New England
                                                                                                                 -2015
                                                                                 MetLife (small group only)
                                                                                                      --2014+2015
                                                                                 Minuteman Health
                                                                                                                  -2014+2015
                                                                                 Neighborhood Health Plan
                                                                                                 -2014+2015
                                                                                 Network Health
                                                                                                    -2014+2015
                                                                                 Tufts Health Plan
                                                                                 MSP
Updated 11/16/2014
National Conference of State Legislatures: Health Insurance Exchanges or Marketplaces: State Actions – March 2015

Exchange           State Decisions/ Structure/ Background 1                Premium             Addressed                          Total Federal Funding
Information                                                                Information         Navigator/Assister                 (2010-2014) 6
by State
Michigan           In 2012, Governor Rick Snyder announced that the        2015 premiums,      Navigators in the state must       $41,517,021 total federal grants
                   state will pursue a state/federal partnership           Healthcare.gov      meet CMS training                  related to exchanges awarded
Federally          exchange, unless the legislature approves pending                           requirements (30 hours of          to the state.
                   legislation to establish a state exchange or HHS        2014 Enrollment     training and web certification).
Facilitated
                   extends the deadlines for the state-run exchanges.      Profile 4/19/14     Click here to view final              $999,772 Planning Grant
Marketplace                                                                                    navigator rule.                    
                                                                           Michigan                                                               st
in Michigan                                                                                                                           $9,849,305 1 Level One
                   On March 5, 2013 HHS conditionally approved the                                                                    Establishment Grant
                   Michigan State Partnership Exchange for 2014.                               Four organizations in the state                       nd
                                                                                                                                      $30,667,944 2 Level One
(State-Federal                                                             HHS report          received navigator grant funds
                                                                           summarizing 2014                                           Establishment Grant
Partnership        Because the legislature did not enact any measures                          from HHS.
Exchange is                                                                plan choices and
                   to address a state or federal partnership, the state
CMS officially                                                             premiums, 9/25/14
                   has defaulted to a federally facilitated marketplace.
approved but not
in operation for
2014-15)
Implementation Facts, Notes and News                                       2015 Insurers: Individual Market
                                                                                                                  -2015
 Allowing Renewals in 2014 w/o Compliance = Yes - Statement
                                                     7
                                                                           Alliance Health and Life Insurance Co.
 2014 ACA Insurance Reforms are in State Law = Yes
                                                       8
                                                                           Blue Care Network of Michigan
 State is not using employee choice of insurers in SHOP for 2015          BCBS of Michigan
 Michigan Health Insurance Marketplace: Overview and Operations-          Consumers Mutual Insurance of Michigan (CO-OP)
   August 2014, by Center for Healthcare Research & Transformation         Health Alliance Plan (HAP)
                                                                           Humana Medical Plan of Michigan
                                                                           McLaren Health Plan
                                                                           Meridian Health Plan of Michigan (in 3 counties)
                                                                           Molina Healthcare of Michigan (in 3 counties)
                                                                           Priority Health Insurance Company
                                                                           Total Health Care USA (in 4 counties)

                                                                           Small Group
                                                                                                                  -2015
                                                                           Alliance Health and Life Insurance Co.
                                                                           Blue Care Network of Michigan
                                                                           BCBS of Michigan
                                                                           Consumers Mutual Insurance of Michigan (CO-OP)
                                                                           Health Alliance Plan
                                                                           McLaren Health Plan
                                                                                                   -2015
                                                                           Physicians Health Plan
                                                                           Priority Health Insurance Company
                                                                           United Healthcare Life Insurance Company

                                                                           MSP
11/9/2014
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