Exchange Governance Chart
This chart highlights steps states have taken to create an exchange. If you’d like to read more about exchange policy decisions, check out our State and Partnership Exchange Policy Decisions chart.
This chart is a collaborative effort with you, the user. Know of something we should add to this compilation? Eager to update a fact we’ve included? Your feedback is central to our ongoing, real-time analytical process, so please let us know via email at calberts@oldsite.nashp.org.
| State Full | State | Establishment Grant Level | Exchange Established | Exchange Design | Exchange Governance | Exchange Director | Exchange Board Appointed |
| Alabama | AL | Level 1 | Federally Facilitated Marketplace | ||||
| Alaska | AK | Federally Facilitated Marketplace | |||||
| Arizonia | AZ | Level 1 | Federally Facilitated Marketplace | ||||
| Arkansas | AR | Level 1 | State-Partnership Marketplace | Cheryl Smith | |||
| California | CA | Level 1 and Level 2 | Legislation | State-Based Marketplace | Independent public agency | Peter V. Lee | Yes |
| Colorado | CO | Level 1 and Level 2 | Legislation | State-Based Marketplace | Quasi-governmental entity | Kevin Patterson | Yes |
| Connecticut | CT | Level 1 and Level 2 | Legislation | State-Based Marketplace | Public non-profit corporation | James Wadleigh | Yes |
| Deleware | DE | Level 1 | State-Partnership Marketplace | Laura Howard | |||
| District of Columbia | DC | Level 1 and Level 2 | Legislation | State-Based Marketplace | Independent authority that is legally separate from the DC government. Housed at Department of Health Care Finance. | Mila Kofman | Yes |
| Florida | FL | Federally Facilitated Marketplace | |||||
| Georgia | GA | Federally Facilitated Marketplace | |||||
| Hawaii | HI | Level 1 and Level 2 | Legislation | Federally Facilitated Marketplace | Yes | ||
| Idaho | ID | Level 1 | Legislation | State-Based Marketplace | Independent public corporation | Pat Kelly | Yes |
| Illinois | IL | Level 1 | State-Partnership Marketplace | Karen Woods | |||
| Indiana | IN | Level 1 | Federally Facilitated Marketplace | ||||
| Iowa | IA | Level 1 | State-Partnership Marketplace | ||||
| Kansas | KS | Federally Facilitated Marketplace | |||||
| Kentucky | KY | Level 1 | Executive Order | State-Based Marketplace | New office within the Cabinet for Health and Family Services | Carrie Banahan | |
| Louisiana | LA | Federally Facilitated Marketplace | |||||
| Maine | ME | Level 1 | Federally Facilitated Marketplace | ||||
| Maryland | MD | Level 1 and Level 2 | Legislation | State-Based Marketplace | Quasi-governmental entity | Carolyn Quattrocki | Yes |
| Massachusetts | MA | Level 1 and Level 2 | Legislation | State-Based Marketplace | Quasi-governmental entity | Louis Gutierrez | Yes |
| Michigan | MI | Level 1 | State-Partnership Marketplace | ||||
| Minnisota | MN | Level 1 and Level 2 | Legislation | State-Based Marketplace | State board | Allison O’Toole | Yes |
| Missippi | MS | Level 1 | State-based SHOP; Federally Facilitated Marketplace | Within the existing CHIRPA, which is a nonprofit entity. | Not applicable | ||
| Missouri | MO | Level 1 | Federally Facilitated Marketplace | ||||
| Montana | MT | Federally Facilitated Marketplace | |||||
| Nebraska | NE | Level 1 | Federally Facilitated Marketplace | ||||
| Nevada | NV | Level 1 and Level 2 | Legislation | Federally-Supported State-Based Marketplace | Individual public entity | Bruce Goldberg | Yes |
| New Hampshire | NH | State-Partnership Marketplace | |||||
| New Jersey | NJ | Level 1 | Federally Facilitated Marketplace | ||||
| New Mexico | NM | Level 1 | Legislation | State-based SHOP; Federally-Supported State Based Marketplace | Nonprofit public corporation | Amy Dowd | Yes |
| New York | NY | Level 1 and Level 2 | Executive Order | State-Based Marketplace | Within the existing Health Department | Donna Frescatore | Not applicable |
| North Carolina | NC | Level 1 | Federally Facilitated Marketplace | ||||
| North Dakota | ND | Federally Facilitated Marketplace | |||||
| Ohio | OH | Federally Facilitated Marketplace | |||||
| Oklahoma | OK | Federally Facilitated Marketplace | |||||
| Oregon | OR | Level 1 and Level 2 | Legislation | Federally-Supported State-Based Marketplace | Public Corporation | Berri Leslie | Yes |
| Pennslyvania | PA | Level 1 | Federally Facilitated Marketplace | ||||
| Rhode Island | RI | Level 1 and Level 2 | Executive Order | State-Based Marketplace | New division within the executive branch | Zachary Sherman | Yes |
| South Carolina | SC | Federally Facilitated Marketplace | |||||
| South Dakota | SD | Level 1 | Federally Facilitated Marketplace | ||||
| Tennessee | TN | Level 1 | Federally Facilitated Marketplace | ||||
| Texas | TX | Federally Facilitated Marketplace | |||||
| Utah | UT | Level 1 | Legislation | State-based SHOP; Federally facilitated individual exchange | Department within Office of Consumer Health Services | Patty Connor | Not applicable |
| Vermont | VT | Level 1 and Level 2 | Legislation | State-Based Marketplace | Within the existing Department of Vermont Health Access | Steven Constantino | Not applicable |
| Virgina | VA | Level 1 | Federally Facilitated Marketplace | ||||
| Washington | WA | Level 1 and Level 2 | Legislation | State-Based Marketplace | Non-governmental, public/private entity | Pam MacEwan | Yes |
| West Virgina | WV | Level 1 | Legislation | State-Partnership Marketplace | |||
| Wisconsion | WI | Federally Facilitated Marketplace | |||||
| Wyoming | WY | Federally facilitated exchange |
Notes
1 State abbreviations are linked to exchange websites, where available.
2 For more information on state exchange establishment grants check out our chart and the full list from HHS.
3 For more in-depth analysis of state exchange legislation and board composition, check out our legislation chart.
4 CHIRPA is governed by a nine-member board.
5 Risk adjuster board sets policies related to defined contribution market but does not oversee operations.
6 The Exchange is administered by the Department of Vermont Health Access in consultation with the Medicaid and Exchange Advisory Committee.
7 Total includes Massachusetts, which created the Connector in 2006, prior to the ACA.
Chart Produced by: Rachel Dolan, Sarabeth Zemel and Jeanie Donovan
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
