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April 2012 St@teside

Exchange Updates


In December 2011, the state formally announced that it would not pursue a state-based exchange. In early April, CMS officials were in Little Rock to officially launch the partnership exchange. For more information regarding initial plans, please visit here. The state has received a $7.7 million Level I grant from CMS to support the planning efforts to build the partnership exchange.


The Colorado Health Benefit Exchange recently released a Small Business Tax Credit Calculator Tool.  The calculator provides two inputs: an estimated tax credit for 2010‐2013 and a tax credit estimate for 2014 and later.


Governor O’Malley will soon be signing HB 443 – The Maryland Health Benefit Exchange Act of 2012 – a product of a deliberative process to continue to support the framework and build the operations of the state’s health insurance exchange. While a detailed summary of the bill can be found here, the most significant policies to be implemented include:

  • Health Plan Participation Criteria: From 2014-2016, the criteria for health plan participation include the minimum ACA requirements as well as an ability to require transition of care language in contracts to ensure care continuity and reduce duplication and costs of care; after 2016, the exchange may use alternative contracting options and active purchasing strategies to increase affordability and quality of care for consumers and lower costs in the health care system overall;
  • SHOP Exchange: the exchange will operate individual and small-business markets separately;
  • Navigators: establishes navigator programs to provide outreach and assistance to consumers as well as requires training, certification, or licensing by the Maryland Insurance Administration. Brokers will be allowed to sell plans in both exchanges;
  • Certification of Benefit Plans: outlines the types of health, dental, and vision plans that can be offered in the exchange; and
  • Essential Health Benefits: outlining the process by which the Health Care Reform Coordinating Council will hold a public stakeholder process to select the state’s benchmark plan by September 30, 2012.

    The bill also calls for the exchange to study several issues, including:
  • In coordination with the Department of Health and Mental Hygiene and the Insurance Administration, assess the costs and benefits of continuity of care requirements in all benefit programs (including Medicaid and CHIP) offered in the state. Report and recommendations are due December 1, 2012.
  • Whether the exchange should be turned into a non-profit organization. Report and recommendations due by December 1, 2015.
  • Whether an alternative risk adjustment program would be more effective than the model selected for implementation in 2014. Report and Recommendations due by December 1, 2015.
  • Whether the SHOP and the individual exchange should be merged. Report and recommendations due by December 1, 2016.

The legislature also adopted the exchange board’s recommendation for further study of a feasible financing mechanism to assure that the exchange is self-sustaining by 2015. Consequently, the legislation establishes a joint legislative-executive branch task force to study and make recommendations by December 1, 2012.

New York

On April 12, New York Governor Andrew Cuomo signed an Executive Order establishing a state health insurance exchange inside the New York Department of Health.


The Oregon Health Insurance Exchange launched its new website this week including a new feature, an Individual Health Plan Savings Calculator. The calculator provides rough estimates of whether consumers may receive help paying for health plans through the Exchange in 2014.