St@teside

On February 22, the Centers for Medicare & Medicaid Services (CMS) announced the fourth round of Level One Establishment Grants to help states set up their health insurance exchanges.

A total of $229 million was awarded to 10 states, including:

• Arkansas, $7.7 million;
• Colorado, $18 million;
•     Kentucky,  $57.9 million;
•     Massachusetts, $11.6 million;
•     Minnesota, $26.1 million;
•     Nevada, $15.3 million;
•     New Jersey, $7.7 million;
•     New York, $48.5 million;
•     Pennsylvania, $33.8 million; and
•     Tennessee, $2.2 million.

Arkansas, Colorado, Massachusetts, New Jersey, and Pennsylvania are first-time awardees.

The deadline to apply for both Level One and Level Two grants has been extended through the end of 2014.  Though states are not required to have an official governance structure (either through legislation or through executive order) prior to receiving a Level One Grant, they must have such a structure in place in order to apply for a Level Two Grant.

The California Health Benefit Exchange released two Requests for Proposal (RFPs). One is for the design and development of the Small Business Health Options Program (SHOP).  The second is to provide project management and technical support consulting services and assist in setting up the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS).

The exchange also awarded one contract and announced the intention to award another contract.  PricewaterhouseCoopers has been awarded a contract to help establish standards for qualified health plans (QHPs) and to develop programs and policies that would promote improvements of the health care delivery systems in the exchange. Ogilvy Public Relations Worldwide will be awarded a contract for the communications support for the outreach and education campaign.

On March 9, the Connecticut Health Insurance Exchange released an RFI to obtain input on exchange information technology (IT) and business processes that support a variety of functions including: eligibility and enrollment, management of QHPs, premium determination and calculation of tax credits and cost-sharing reductions, SHOP, broker/navigator relationship management, marketing and outreach, cost estimate and financial management and reporting. The state also announced its intent to submit a Level One Exchange Establishment Grant application in March.

Both the House and the Senate bills that would have created a state-based exchange in Florida and the Florida Health Benefits Exchange Legislative Study Committee to examine a variety of design and operations issues, failed on March 9, 2012. 

In Idaho, House Concurrent Resolution 45 indicates that a state-based exchange would not have desired results and encourages health insurance providers to develop private health insurance exchanges.

A bill that would have established a state-based exchange in Maine failed in the Legislature's Insurance and Financial Services Committee. State legislators decided to wait for the U.S. Supreme Court’s decision on the constitutionality of the Patient Protection and Affordable Care Act (ACA).¹

The Minnesota Department of Commerce released an RFP for assistance with public outreach and education for the exchange. The RFP has three sections: market research, branding, and public relations. Vendors can submit proposals for one, two, or all three pieces.

New Hampshire introduced a House bill that would require the state to return $333,000 in exchange planning grant money to the federal government. In 2011, the state passed legislation preventing the use of $666,000 from the $1 million planning grant.

On March 15, 2012, a New Jersey bill that would establish a state-based exchange passed both houses. The exchange would be located administratively within the Department of Banking and Insurance, but would be independent from the department. However, Governor Chris Christie has indicated his intent to wait for the U.S. Supreme Court’s decision.²

In New York, the Senate introduced two exchange-related bills. One would amend the executive budget bill to remove a section of that bill that would have established a state-based exchange as a public authority. The second bill would establish a commission to study whether New York should create a state-based exchange, pursue a partnership with other states, or defer the decision until 2013.

The Oklahoma legislature decided to withdraw a bill that would have established a state-based health insurance exchange. State legislators decided to wait until the U.S. Supreme Court rules on the constitutionality of the ACA.³

In Pennsylvania, bills in both the Senate and the House have been introduced to amend the state Constitution to prohibit a mandate requiring individuals to buy health insurance coverage. The bills would also prohibit fines against individuals who fail to obtain or maintain health insurance coverage.

On February 24, 2012, Vermont’s House passed a bill that lays out issues related to the implementation of state’s single payer system. The bill is currently on the Senate floor.  The state is also seeking input from insurers and brokers on issues related to both SHOP and individual exchanges.

In Wyoming, Governor Matt Mead signed a bill to reauthorize the Wyoming Health Insurance Exchange Steering Committee to continue studying the development of a state-based exchange.  According to the bill, if the committee recommends that the state pursue a state-based exchange, it should consider creating one based on the following three options:

• An exchange that is based on Wyoming data without influence from the health care reform law;
• An exchange that is based upon Wyoming data and is in compliance with those aspects of the health care reform law that fit the needs of Wyoming as the steering committee recommends; and
• An exchange that is in complete compliance with the health care reform law.

The Wyoming bill also prohibits the state from applying for Level One and Level Two Establishment Grants until the U.S. Supreme Court rules on the constitutionality of the ACA.

¹Mainebiz. (2012, March 19). Committee nixes health insurance exchange bill.  Retried March 19, 2012, from http://www.mainebiz.biz/apps/pbcs.dll/article?AID=/20120319/NEWS0101/120319960.

²Washburn L. (2012, March15).  NJ Senate, Assembly pass state health insurance exchange bill. Retried March 19, 2012, from http://www.northjersey.com/news/NJ_Senate_Assembly_pass_state_health_insurance_exchange_bill.html?page=all.

³BNA’s Health Care Policy Report. (Subscription only). (2012, March 19). State Delays Action on Exchanges Until Supreme Court Ruling on PPACA. Retrieved March 19, 2012 from http://news.bna.com/hcln/HCLNWB/split_display.adp?fedfid=24834092&vname=hcpnotallissues&jd=a0d0y6d1t5&split=0.