The last of 19 states got federal approval to start their new healthcare exchanges, created under the Affordable Care Act.  California, Hawaii, Idaho, Nevada, New Mexico, Vermont and Utah all got approval from the Health and Human Services Department to operate their healthcare exchanges.

Exchanges are designed to serve as a place where individuals and businesses can shop for coverage with the help of easy-to-understand information on all their options. Plans sold through exchanges will have to meet certain standards so that consumers get good value for their money. The exchanges will serve an important purpose for people who are middle or low-income.  A well-designed exchange will allow those without insurance through their employer to comparison shop for plans along the same lines as shopping for the best airfare on a travel website. 

The 19 states that have declared and been approved for state run exchanges are Maryland, Rhode Island, Colorado, Connecticut, Washington, Hawaii, Idaho, Vermont, Kentucky, California, Massachusetts, Utah, Minnesota, Mississippi, Nevada, New Mexico, New York, Oregon, and District of Columbia.  States planning to operate a state-based exchange will perform all exchange-related activities, including contracting with health plans, providing consumer outreach and assistance, and building the necessary information technology infrastructure to assess eligibility and enroll individuals into coverage. States have the option of using federal services to determine eligibility for premium tax credit and cost-sharing reductions, as well as to operate the risk adjustment and reinsurance programs.

The seven states that will have a partnership exchange are Arkansas, West Virginia, Delaware, Illinois, Iowa, Michigan, and North Carolina.  The partnership exchange allows for the combined management of exchange functions and for an easier transition to a fully state-based exchange in the future.  These states can choose to operate certain plan management functions, certain consumer assistance functions, or both. In addition, a partnership state can elect to conduct Medicaid and Children’s Health Insurance Program (CHIP) eligibility determinations or allow the federal government to perform this service.

In all partnership states, Health and Human Services will perform the remaining exchange functions and ensure the exchange meets ACA standards.   States opting for a state-federal partnership exchange must submit a blueprint to HHS by February 15, 2013. HHS will issue approvals for partnership exchanges on a rolling basis beginning on March 1, 2013.

States have flexibility in determining the role of the exchange with respect to contracting with health plans. All exchanges are required to contract only with health plans that meet minimum federal requirements for qualified health plans. States can choose to have the exchange contract with all qualified health plans (clearinghouse) or states can choose to have the exchange contract with selected health plans and/or negotiate premium prices with health plans (active purchaser).

The remaining 25 states have opted to leave the Federal Government responsible for setting up their exchanges.  Those states are Wyoming, Tennessee, South Carolina, South Dakota, North Dakota, Maine, Pennsylvania, Louisiana, Oklahoma, Ohio, Texas, Florida, Kansas, New Hampshire, New Jersey, Arizona, Nebraska, Montana, Alaska, Indiana, Virginia, Alabama, Wisconsin, Georgia, and Missouri.