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December 11, 2012

HHS Secretary announces the conditional approval of the health insurance exchange plans of six states

By Susan L. Smith JD, MA

Six states have received early conditional approval of their state-based Health Insurance Exchanges and are on track to meet all Exchange deadlines, according to an announcement on December 10, 2012, by the Secretary of HHS, Kathleen Sebelius. The six states are Colorado, Connecticut, Massachusetts, Maryland, and Washington. HHS is reviewing applications from other states and will make more announcements regarding approval of state plans in the weeks to come. Sebelius expects the majority of states to play an active role in operating their Exchanges and noted that if states decide to play a larger role in health insurance exchanges in 2015, 2016 and beyond that HHS will work with the state to provide that opportunity.

Conditional approval. CMS' conditional approval of these states plans was based on the state exchange's self-assessment, progress to date, and expected progress across the entire spectrum of Exchange requirements, and is contingent on one or more of the following conditions depending on CMS' specific conditions for each state: (1) timely demonstration of the ability to perform all required Exchange activities in line with the attestations the state has made in its Exchange Blueprint Application submission; (2) ongoing compliance with future guidance and regulations (during the first year of the program, plan year 2014, approval of a state-based exchange will account for timelines related to guidance and infrastructure development); and (3) ability to collect forms as part of the qualified health plan (QHP) certification process (for example, see the HHS Secretary's letter to the Governor of Colorado).

Letter to Governors. Because of states that have requested additional guidance in implementing the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148), Sebelius sent a letter to Governors on December 10 providing more information and answering questions that states have been asking. In the letter, Sebelius encourages all states to take advantage of federal matching funds to cover more of their residents and reminds Governors that in addition to providing Americans with access to new markets with more quality insurance choices, PPACA allows states to expand their Medicaid programs and that the federal government will pay 100 percent of the cost of all newly eligible residents in Medicaid for three years beginning in 2014. An enclosure provides answers to frequently asked questions on Exchanges, market reforms, and Medicaid. The questions and answers explain how Exchanges and Medicaid administrative costs will be funded and how HHS will continue to explore opportunities to provide states with additional support for the administrative costs of eligibility changes. In addition, HHS clarifies that states have the flexibility in Medicaid and the Children's Health Insurance Program to provide premium assistance for Exchange plans as well as adopt "bridge plans" that offer coverage through both Medicaid and Exchanges. HHS also explains how it will work with state policymakers to make sure that the Federally-Facilitated Exchanges account for specific state needs, how will they be funded, whether states will be reimbursed for services it provides, and provides answers to additional questions specifically related to Federally-Facilitated Exchanges. Other topics included in the questions and answers are multi-state plans, bridge plans, basic health plan, consumer outreach, consumer eligibility and enrollment, consumer experience, flexibility for states, and coordination between Exchanges and other programs.

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