The Maryland Exchange Leaps into the New Year

Maryland is leaping into 2012 with an active exchange agenda. In a December 2011 report to the governor and legislature, the Maryland Health Benefit Exchange Board issued the first comprehensive set of policy recommendations we’ve seen from a state exchange.
The report compiles advisory committee reports based on consultants’ analyses on six topics—the operating model, market rules, the navigator program, SHOP exchange, sustainability, and public relations—and makes a total of 27 recommendations. This recommendation process was called for in Maryland’s exchange enabling legislation passed in 2011.
We’ve highlighted a few of Maryland’s recommendations that may be of interest to your state, and we want to know what exchange decisions your state is making, too. Let us know in the comments below this list of Maryland ideas.
Operating Model
The Maryland Health Benefit Exchange Board recommends the Exchange have the ability to set requirements for Qualified Health Plans above the minimum established by the Affordable Care Act (ACA). The board believes, over time, active purchasing can improve quality, outcomes, and affordability of health care in the state, but carrier participation is also crucial to the success of the Exchange. The board recommends the Exchange have the ability to set a floor above the minimum requirements in the ACA, but all plans that meet those requirements be allowed to participate.
Market Rules
Plans operating exclusively outside of the Exchange have the potential to create an adverse selection problem and the Exchange Board makes some recommendations in attempt to mitigate that risk. For example, the board proposes that insurance carriers with certain characteristics must offer plans inside the Exchange, including carriers that offer ACA-defined catastrophic plans. The board also recommends that carriers must participate in the individual market if the revenue exceeds $10 million dollars and must participate in the small group market if their annual premium revenue exceeds $20 million dollars. The board also recommends the Exchange have the flexibility to adjust this threshold over time.
Small Business Health Options Program (SHOP)
The board recommends the individual and small group markets remain separate in 2014, but proposes to reassess this decision in 2016. The board also recommends keeping the definition of small group the same (rather than expanding to employers with 51-100 employees) and proposes that the SHOP exchange only offer the federally required level of choice for employees, as too much choice could lead to adverse selection. This means the SHOP exchange will allow the employer the option to choose an actuarial level and employees may choose plans at that level. Once the market stabilizes, the board recommends the Exchange reevaluate employee choice options in 2016.
Navigator Program
The board also makes a series of recommendations regarding the navigator program, including:

• Creating two separate navigator programs: one for the small group market and one for the individual market. This recommendation stems from the differences between the two markets and the unique needs of small businesses.
• Allowing agents and brokers to sell insurance plans in both markets, but not be compensated as navigators. Navigators would be compensated through grants from the Exchange, and agents and brokers would be paid by carriers.
• Creating a certification program for navigators, rather than requiring them to be licensed as producers.
• Working with Medicaid to integrate the navigator program with Medicaid outreach and enrollment.

Next Steps
A number of the board’s recommendations will require legislative action. The Exchange will work with the governor to determine which policies need legislation, and to draft needed legislative language for the 2012 legislation session that began on January 10.
Is your state making exchange policy decisions? Tell us in the comments below!