State Exchange Decision Roundup

Now that the Supreme Court has ruled on health reform, it’s decision time for states on health insurance exchanges. States that choose to establish a state-based exchange must submit, by November 16, 2012, a blueprint affirming their intention to establish a state-based exchange.  For states that have not yet acted to establish an exchange, but want to move forward with one, this deadline may be challenging. Most state legislatures are now out of session, so creating the legal authority for an exchange could require a special legislative session or an executive order from the governor.  States can also decide not to establish a state-based exchange, and instead, defer to a federally-facilitated exchange (FFE), or only take on some responsibility through thepartnership model.  HHS has tried to encourage states to move forward by releasing a new funding opportunity announcement for exchange establishment grants, which allows states to apply for funding through 2014.
Whether your state is humming along, working to catch up, or weighing its options, we hope our new exchange decision chart will help you.  The chart tracks governance, leadership, and key policy decisions related to the SHOP exchange, navigator programs and exchange financing. We have included links to all our sources, so you can easily trace the decisions back to their source.
Small Business Health Options Program (SHOP) Exchange
States can choose to combine and administer their SHOP exchange with their individual exchange or keep them separate. The state also has a choice about whether to merge the risk pools for the two markets.

• Vermont’s legislation combines both the small group and individual markets and also requires that all small group plans be sold through the exchange.
• California’s exchange enabling legislation requires that the SHOP and individual exchanges be administered separately and that the markets remain separate, at least initially, with a report due in 2018 analyzing the implications of merging the markets. The exchange board recently appointed a SHOP Director.
• Colorado’s exchange board voted to combine the administration of the SHOP and individual exchanges, but keep the risk pools separate.

Navigator Program
Exchanges are required to set up a navigator program to assist consumers with enrollment. States are taking varying approaches to the program based on their policy goals and what makes sense for them.

• California is setting up an assister program that will include comprehensive application assistance. Navigators will be a subset of “certified enrollment assisters” that are compensated by the exchange, and will include groups like nonprofits, unions and clinics.
• Oregon is developing an Agent Management Program so that the exchange will be able to work with a network of insurance agents to sell plans in the exchange.
• Hawaii’s interim board recommended that only nonprofit entities be able to participate in the navigator program.
• West Virginia has released a Request for Quotation (RFQ) for an analysis of the navigator program.

Financing
Beginning in 2015, exchanges must be self-sustaining and can no longer rely on the federal funding that states are using to develop and build their exchanges. States are examining a variety of options to help fund their exchanges.

• Nevada’s exchange board has approved charging user fees for standalone vision and dental products, as well as offering advertising on the exchange website. One of the exchange’s advisory committees recommends financing the exchange through an enrollment-based assessment on carriers, but the board has not yet made a final decision.
• Connecticut’s exchange board recommends charging an assessment on premiums purchased through the exchange.
• Washington has developed budget projections and is examining a number of financing options, including assessments and advertising revenue. The full board will decide on recommendations by November and submit a report to the legislature in December.

What decisions is your state working on related to exchanges? Tell us in the comments below and we’ll update our chart!