Health Insurance Exchanges or Marketplaces: State Profiles and Actions
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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.
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
MSPNational 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 PartnersNational 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 11/12/2014National 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
MSPNational 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 1/13/2015National 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 HealthcareNational 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 11/10/2014National 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 optionsNational 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 1/5/2015National 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 PermanenteNational 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
11/15/2014National 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 11/16/2014National 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 1/5/2015National 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 1/12/2015National 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 11/15/2014National 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
MSPNational 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
*MSPNational 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)
*MSPNational 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
MSPNational 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 11/16/2014National 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
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