North Dakota and Virginia Intend to Establish Health Insurance Exchanges
At least 35 states have decided whether to establish a health insurance exchange as addressed in the Affordable Care Act or whether to study related issues. Although some states are considering the governance and structure of their exchange, such as who will serve on oversight boards and which entity will run the exchange, a few states have taken different approaches. Lawmakers in North Dakota and Virginia adopted legislation to create state-based exchanges, without determining a lot of specifics on the structure and governance. Both states provide deadlines and assign entities (such as health and insurance agencies) to provide detailed recommendations about governance and structure that will be reviewed within the next couple of legislative sessions.
The North Dakota insurance commissioner and the Department of Human Services are responsible for a large portion of the planning and development of health benefit exchanges in the state. The commissioner and the department will work together and collaborate with appropriate contractors, agencies and the legislature to ensure that an exchange is up and running by Jan. 1, 2014. They will provide periodic updates to a legislative management team. Because the North Dakota Legislative Assembly meets every other year, if legislative action is required before Jan. 1, 2013, the commissioner and department are required to submit legislation for consideration during a special session. For any action needed after Jan. 1, 2013, the commissioner and department must propose legislation by Oct. 15, 2012, for the 2013 session.
Lawmakers in Virginia created a state-based exchange to avoid a federally run one. Under their law, the governor and the secretary of Health and Human Resources will work with the General Assembly, experts and others to recommend a structure and governance of the exchange. The governor’s recommendations will be presented to the General Assembly by Oct. 1, 2011, allowing time for related bills to be considered during the 2012 session.
States to Address “Dual Eligibles”
“Dual eligibles” (people who are eligible for both Medicare and Medicaid) are among the most chronically ill and costly individuals enrolled in both programs because many of them suffer from several chronic conditions and require long-term care. For states, Medicaid spending on these people is on average more than six times higher than on adult Medicaid beneficiaries who are not disabled.
The Federal Coordinated Health Care Office and the Center for Medicare and Medicaid Innovation (Innovation Center) recently selected 15 states—Calif., Colo., Conn., Mass., Mich., Minn., N.Y., N.C., Okla., Ore., S.C., Tenn., Vt., Wash and Wis.—to receive up to $1 million each through the Affordable Care Act to design integrated care models for this population.
According to the Innovation Center, the states will design a plan for providing “person-centered” care that “coordinates primary, acute, behavioral and long-term supports and services for dual eligible individuals.”
In addition to containing costs and providing better care, CMS officials hope this initiative will lead to the “elimination of unnecessary and inefficient conflicts in the regulatory, statutory, and policy requirements of the two programs, where feasible.”
For more information, read the CMS Fact Sheet on Dual Eligibles.
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