The Department of Health and Human Services (HHS) has released a "Blueprint" describing the process by which states must apply to obtain approval to operate an insurance exchange beginning in 2014. The document also details the features and activities an exchange will be required to offer.
Although the finer points of this document are primarily of interest to states that will be seeking to operate an exchange (either alone or in partnership with the federal government), it provides employers some sense of how and when the exchanges will come together. Among the highlights:
- There are three exchange models: (1) state-based exchanges (operated largely by the states); (2) state partnership exchanges (operated largely by the federal government but with some state involvement); and (3) federally facilitated exchanges (operated almost exclusively by the federal government).
- States wanting to participate under any of these models must receive approval or conditional approval from HHS by January 1, 2013. A "declaration letter" and "exchange application" must be submitted no later than November 16, 2012.
- An exchange must be operational for an open-enrollment period beginning October 1, 2013.
- Required exchange activities will include (1) providing consumer support for coverage decisions; (2) facilitating eligibility determinations for individuals; (3) providing for enrollment in qualified health plans (QHPs); (4) certifying health plans as QHPs; and (5) operating a Small Business Health Options Program (SHOP).
From this we can see that the exchange landscape will be better defined by January 1, 2013, once it is clear which states have received HHS approval and which states have not. We can also see that October 1, 2013 will be an important date, as individuals (and small businesses) are able to begin enrolling for exchange-based coverage and may be looking to compare that coverage with employer-provided coverage.
The blueprint also makes clear that a state's application for approval must be signed by the governor. In Kansas, Governor Brownback has given every indication that he does not support establishing a state-based exchange. Since his signature would be required, it seems fair to assume at this point that Kansas will not have a state-based exchange, at least for 2014.