Four More States Apply to Operate Partnership Health Insurance Exchanges

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Applications to operate state partnership health insurance exchange markets under the health care reform law were received from Iowa, Michigan, New Hampshire, and West Virginia by the Feb. 15 deadline, bringing the total number of states that have applied to either run their own exchanges or partner with the federal government to 24 and the District of Columbia, Department of Health and Human Services Secretary Kathleen Sebelius said in a blog posted Feb. 19.  

HHS has given conditional approval for Arkansas, Delaware, and Illinois to operate state partnership exchanges under which states can approve plans and/or conduct consumer outreach (31 HCDR, 2/14/13).

In addition, HHS has given conditional approval to 17 states and the District of Columbia to operate state-based exchanges, in which states run the exchanges in accordance with HHS regulations (03 HCDR, 1/4/13). Mississippi's application to operate a state-based exchange was denied, and Utah's application is pending.

“To date 20 states and the District of Columbia have been conditionally approved to run either a state-based or partnership marketplace in 2014, and this number will grow by March 1,” Sebelius said in the blog.

“In addition, several other states have suggested their own approaches to contributing toward plan management in their Marketplace in 2014,” Sebelius said.

Conditional Approval

Conditional approval means HHS has found that the states are likely to be ready to open the online health insurance markets for enrollment by Oct. 1 to sell individual and small group plans that take effect Jan. 1, 2014.

Under the Affordable Care Act, the federal government will operate federally facilitated exchanges in the 26 states that have not acted to create state-based exchanges or enter into the partnership exchanges. Creating exchanges has proved to be a contentious issue for states that oppose ACA, and Oklahoma is challenging in court whether the federal government can issue premium tax credit subsidies to low- and moderate-income people to purchase health insurance through the federally facilitated exchange.

“2014 is the beginning, not the end,” Sebelius said. “States will have the option to apply to run their own Marketplace in future years.”

By Sara Hansard  

Sebelius's blog, “States Prepare for the Health Insurance Marketplace,” is at

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