State of the States: Health Insurance Exchanges

October 26, 2012

With a significant number of states waiting for the outcome of the November 6 election before making an exchange decision, it was a slow week for exchange developments. However, there was some notable reshuffling within CMS and today the Idaho Health Insurance Exchange Working Group is scheduled to have their final meeting before issuing their exchange recommendation to the Governor. Let’s start at the federal level. 

This week, the Center for Consumer Information and Insurance Oversight (CCIIO) announced that Tim Hill, deputy director overseeing health insurance exchanges, would be leaving his position for another assignment within CMS.  The move comes weeks before states are expected to begin submitting their exchange Blueprints to CMS and just months after the departure of Steve Larsen, former Director of CCIIO. It is unclear who will replace Hill at CCIIO.

Moving to the states, last week Illinois Governor Pat Quinn (D) sent a letter to CCIIO declaring that it was Illinois’ intention to participate in a federal-state partnership exchange. In his letter, Governor Quinn wrote that he hopes Illinois will pass legislation in the near future that would allow the state to operate a state-based exchange by 2015. Illinois is the third state, along with Arkansas and Delaware, to publicly declare its intent to pursue a federal-state partnership exchange. Other states are still examining the partnership option and there could be additional declarations before the November 16 HHS Blueprint deadline.

Meanwhile, a week earlier Governor Dannell Malloy (D-CT) sent HHS a letter requesting “the timely issuance” of regulations “regarding the implementation and operation of a Basic Health Program.” Connecticut has been examining the feasibility of developing a Basic Health Program, but lacks the specific regulations needed to make a formal analysis. In his letter, Governor Malloy points out that the decision to implement a Basic Health Program could impact other health reform efforts in the state, including the state’s health insurance exchange and Medicaid program.

Moving west to Minnesota, during a meeting of the Legislative Advisory Commission to review Minnesota’s previous $42.5 million Level One grant award from HHS, Exchange Director April Todd-Malmlov revealed that the exchange anticipated applying for two additional grants in 2013. The total estimated amount of additional grant funding is expected to range between $60 and $80 million. Also this week in Minnesota, the Health Insurance Exchange Advisory Task Force met to discuss recommendations from the Finance Work Group for the Minnesota Exchange on long-term funding options.

In Idaho, the Idaho Health Insurance Exchange Working Group is scheduled to have their final meeting before releasing their exchange recommendation to the Governor. The working group was created earlier this year by Governor C.L. “Butch” Otter (R) to study the exchange issue and determine what would be the best option for Idaho.

Finally, according to the minutes of a September 25 meeting with stakeholders in West Virginia, the state is exploring “regional exchanges.” West Virginia is working with the National Academy of State Health Policy (NASHP) to “research potential regional exchanges, develop reciprocal agreements with other states, potentially share risk pools, develop ways to help bring down administrative costs, and explore potential for shared IT systems.” This is not the first time West Virginia has looked to collaborate with other government entities on complex health IT systems. Two weeks ago, it was announced that the Virgin Islands (VI) will be joining West Virginia’s Medicaid Management Information System by July 2013.

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