Highlights from the Second Round of Exchange Establishment Grants

HHS announced the latest round of establishment grant awardees on August 12, 2011. Thirteen additional states and the District of Columbia have now received grants to establish Exchanges, bringing the total to seventeen. The grant application requires states to address eleven core areas identified by HHS in which states are expected to carry out activities. Here at State Refor(u)m, we’ve expanded our original analysis of the grant proposals along these core areas, available here. We will continue to expand this analysis as new proposals are approved.
We took a look across applications from 12 of the new awardees and found some common strategies in what states are doing to tackle the challenge of building an Exchange. Here are some highlights from three core areas of the grant application: stakeholder consultation, program integration and Exchange IT.
What are states doing to engage stakeholders in Exchange development?
Most states are holding statewide meetings to gather input from the public and some have established groups or committees of stakeholders that they convene:

• Oregon held six statewide meetings in 2010 to gather public input and continues to convene aConsumer Advisory Work Group each quarter. The group is comprised of ten members selected for their diverse backgrounds and experience with consumers.
• Missouri convenes two external stakeholder groups regularly. One stakeholder group focuses on insurance and the other focuses on issues related to Medicaid, eligibility and enrollment.
• Connecticut established an Exchange Planning Committee, with representation from state agencies, consumer advocates and industry organizations. The Committee provided feedbackon a number of Exchange related issues, including a stakeholder outreach plan. The state also held public forums and stakeholder sessions throughout 2011.

What are states doing to ensure programs work together to build Exchanges?
Many states have created interagency workgroups:

• Missouri established the Health Insurance Exchange Coordinating Council (HIECC), composed of agency leaders from the departments of Mental Health, Insurance, Social Services, and Budget and Planning, among others, that oversees Exchange workgroup activity.
• California has created an interagency working group with representatives from Department of Managed Health Care (DMHC), the Managed Risk Medical Insurance Board (MRMIB), and the Office of System Integration. There is also a staff working group from the California Department of Insurance (CDI) and DMHC to work with the Exchange on health plan management issues.

States are also working to determine where new processes will fit into the existing agency framework as well as the Exchange:

• Mississippi has conducted a study to determine how the Exchange can work best with state and federal programs and minimize duplication of effort. Mississippi Insurance Department (MID) staff has also conducted meetings with Medicaid staff and the two agencies plan to continue working together.
• West Virginia is developing strategies to transition programs for the uninsured that will no longer be needed when these populations gain coverage.
• Nevada has collected information on programs with resources that the Exchange can leverage and programs that will need to coordinate with the Exchange. The state has identified five key areas of integration between the Exchange, Medicaid and CHIP: outreach, education and enrollment; covered benefits; provider networks; carriers; state and local governments.

States are creating formal agreements between agencies to better facilitate their coordination of activities:

• The Kentucky Office of Health Policy has drafted agreements with the Department for Medicaid Services and the Department of Insurance regarding their respective roles and responsibilities in Exchange planning.
• In Illinois, the Governor’s Office, Department of Insurance and Department of Healthcare and Family Services have signed an agreement that allows them to share resources, particularly Exchange planning grant funds.
• In Oregon, leadership from Exchange staff, Medicaid, and Insurance are working to clarify responsibilities as they create interagency agreements, especially related to rate review, licensure and certification, development of plan grading criteria, risk adjustment and reinsurance, and consumer protection.

What are states doing to get their IT systems ready for the Exchange?
Looking to Early Innovator states:

• A few states, including Maryland, Oregon and New York are Early Innovator states and are continuing to develop their IT systems under that framework.
• Other states, like Missouri, Kentucky, Nevada and Mississippi plan to leverage the work of these Innovator states.

Participating in multi-state initiatives:

• New York, Minnesota and Illinois are some of the states participating in UX 2014: a multistate project with the aim of designing a “best in class” user experience for online enrollment.  The project is a public-private partnership to develop design elements that can be integrated into state-based eligibility and enrollment systems.

Conducting an IT Gap Analysis:

• All grantees are in the process of or have completed a comprehensive IT gap analysis.
• Mississippi held a webinar for MID and Medicaid staff to share information about their current IT infrastructure with one another.

Check out our collection of state establishment grants here. Is your state working on an Exchange establishment grant application? Please tell us about it and share your state’s grant proposal on your state’s page at State Refor(u)m.