News from Blue Cross and Blue Shield of IL

January 16, 2013

Legislative Update: HHS Releases Additional Guidance to States on Health Insurance Exchanges [All Markets]

On Jan. 3, 2013, the U.S. Department of Health & Human Services (HHS) released additional guidance on the partnership model of a federally facilitated exchange, also known as the state partnership exchange.

In a state partnership exchange, the state has the opportunity to assume what are known as “plan management” functions, and/or certain “consumer assistance” functions. The guidance provides states with additional information as to roles and responsibilities they can, and HHS will, have in these state partnership exchanges.

States have until Feb. 15, 2013, to tell HHS whether they want to participate in state partnership exchange.

Generally, the guidance indicates that HHS plans to have states, in state partnership exchanges, take on significant roles in carrying out plan management and consumer assistance functions in order to prepare those states to eventually transition from a partnership model federally facilitated exchange to a state-based exchange.

However, the guidance also makes clear that even in a state partnership exchange, HHS will remain responsible for its overall operation and will provide oversight to the states to ensure they carry out their exchange-related roles and responsibilities. In a state partnership exchange, HHS will carry out all minimum exchange functions not performed by states, such as enrollment and establishment and maintenance of the exchange website and call center.

The state of Illinois has submitted its blueprint for a state partnership exchange and is awaiting HHS’ approval. On Jan. 3, 2013, HHS conditionally approved New Mexico’s blueprint for its state-based exchange. The Texas and Oklahoma governors have said they will not operate state-based exchanges or participate in a partnership exchange. If a state does not submit its application that is not a partnership model by the deadline, then HHS will establish a federally facilitated exchange in that state.