State Actions to Address Health Insurance Exchanges

Enacted Exchange Established in 2012 --0 States, DC

Did not pass in 2012***--22 States

Alabama, Alaska, Arizona, Georgia, Idaho, Illinois*, Iowa, Louisiana, Maine, Michigan*, Minnesota*, Missouri, Nebraska, New Jersey (AB 2171 and S2135) passed legislature,  both were vetoed by governor), New Mexico, Ohio*, Oklahoma*, Pennsylvania*, Rhode Island*, South Carolina*, Virginia, Wisconsin 

CALIFORNIA
2010 SB 900 and AB 1602

• Declaration Letter
• Conditional Approval from HHS

Independent State Agency

 5 member board

The members of the board have been appointed.
 

 Active Purchaser

Click here for California Exchange web page.

The board appointed an Executive Director on August 25, 2011.

California was the first state to establish state-based exchange under the ACA.

• Conflict of Interest: Members of the board cannot be affiliated with any entity involved in the exchange (carriers, brokers, providers, etc) or benefit financially from the exchange while serving on the board. 
• SHOP and individual exchange are separate, but board has the authority to reevaluate that in 2018.
• Legislation allows the use of navigators, the board is responsible for defining rules on navigator participation.

• $1 million Planning Grant
• $39,421,383 in First Level One Establishment Grant
• $196,479,629 Second Level One Establishment Grant
• The general fund is allowing a $5 million loan to establish the exchange.

COLORADO
2011 SB 200, Chapter No. 246

• Declaration Letter
• Conditional Approval from HHS

 Non-Profit

12 member board

Governor Hickenlooper appointed members on June 29, 2011.
Click here for Board Information and Resource Page. .

Not an Active Purchaser 

The Colorado Health Benefit Exchange Web Site is now available.

The governing board appointed an executive Driector in December 2011.

Bi-Partisan legislation

• The bill also creates the Legislative Health Benefit Exchange Implementation Review Committee.
• Conflict of Interest: Members of the board may not make decisions that benefit them financially.
• SHOP and Individual Exchange are two separate markets, but the board has the option to review this and merge them if they see fit. 
• Advisory groups can be used to provide recommendations to the board.

• $999,987 Planning Grant 
• $17,951,000 First Level One Establishment Grant
• $43,486,747  Second Level One Establishment Grant
• The exchange cannot use general funds in establishing or operating the exchange.

CONNECTICUT
2011 SB 921, Public Act 11-53

• Declaration Letter
• Conditional Approval from HHS

Quasi-Public Agency

14 member board 

Membership of the board was announced on August 25, 2011.

Active Purchaser 

Click here to visit Connecticut Exchange web site.

In January 2012, Mercer Health & Benefits released a planning report.

• Conflict of Interest: Does not allow any representative of the insurance industry or providers as board members.
• The Exchange is to submit a plan by January 1, 2012 on whether or not to merge the SHOP and individual exchange, or whether the state should include mandated benefits in addition to the essential health benefits for qualified health plans.
• The board is also required to address how they will deal with navigators (brokers/agents).

• $996, 848 Planning Grant
• $6.7 million Level One Establishment Grant
• $107,358,676 Level Two Establishment Grant
• Connecticut was among the consortia of New England states to receive the "Early Innovator" cooperative agreement for a total of $35,591,333.

DISTRICT OF COLUMBIA

2012 ACT 19-269

• Declaration Letter
• Conditional Approval from HHS

Independent Authority of the District Government

The exchange will certify qualified health plans in the exchange.

• Conflict of Interest: Each member of the executive board shall serve the public interest of the individuals and small businesses seeking health coverage through the exchanges and ensure operational effectiveness and fiscal solvency of the exchange.
• The executive board may merge the exchanges for individuals and the SHOP exchange, if a merged exchange is in the best interest of the District.
• The exchange will select entities qualified to serve as navigators.
• The legislation also allows a nine member advisory board in addition to the executive governing board.

• Planning Grant: $1 million
• $ 8,200,716 Level One Establishment Grant
• $72,985,333 Level Two Establishment Grant

HAWAII
2011 SB 1348
Act 205

• Declaration Letter
• Conditional Approval from HHS

 Non-Profit

Interim Board until 15 Member board is appointed by July 1, 2012.

The Insurance Commissioner will determine eligibility for plans, but all plans that apply will be included in the exchange.

The Hawaii Health Connector will work with the Hawaii Prepaid Health Care Act.

The interim board produced its final report in Decmeber 2011.

• Conflict of Interest: The board will set policies and determine how to handle conflict of interest.
• Interim board will make recommendations regarding a funding plan (not allowed to use state funds), conflict of interest criteria, board member terms, among other items by the 2012 legislative session.

• $1 million Planning Grant
• $14,440,144 First Level One Establishment Grant
• $61,815,492 Second Level One Establishment Grant
• Not allowed to use state funds for the operation of the exchange.

ILLINOIS
2011 SB 1555 Public Act 97-0142

On October 16, 2012, Illinois announced that it will work with the federal government to run the exchange in the state. The state intends to transition to a fully state operated exchange within a year of partnership operation.
In 2011, this bill intended to establish a state based health insurance exchange. The act creates an Illinois Health Benefits Exchange Legislative Study Committee to inquire further into the establishment of the Illinois Health Benefits Exchange.

The Legislative Study Committee will report its findings to the executive and legislative branches and make recommendations on the governance, structure, operating models and standards of the Exchange. In October 2011, the committee provided a report titled, Findings of the Illinois Legislative Health Insurance Exchange Study Committee.

According to the state's health reform website, " Additional legislation to establish governance and financing structure of the Exchange in Illinois is currently being assessed in the Illinois General Assembly."

•  $1 million Planning Grant
• $5,128,454 First level one establishment grant
• $32,789,377 Second level one establishment grant
   

MAINE
Resolve Chapter 105

For recent, executive branch announcements and decisions, click here. In 2011, this bill created the Advisory Committee on Maine's Health insurance Exchange. The committee is to develop and provide recommendations (including suggestions on enabling legislation to the governor and the legislature. The advisory committee has up to 9 members.

• $1 million Planning Grant
• $5,877,676 Level One Establishment Grant
• Maine was among the consortia of New England states to receive the "Early Innovator" cooperative agreement for a total of $35,591,333.

MARYLAND
2011 SB182 (Chapter 1) and 
2011 HB 166 (Chapter 2)  

• Declaration Letter
• Conditional Approval from HHS

Independent State Agency

9 member board

Governor O'Malley appointed members on May 26, 2011.
 

The board will decide as part of their planning.  

In August 2012, launched the Maryland Health Connection, its official name, logo and website.

Click here to visit the exchange web site.

In December 2011, the board submitted a letter and recommendations to the governor and legisalture.

The board appointed an Executive Director on August 16, 2011.

• Conflict of Interest: Members of the board cannot be affiliated with any entity involved in the exchange (carriers, brokers, providers, etc) or benefit financially from the exchange while serving on the board.
• The board will provide recommendations on financial structure, whether or not the SHOP and individual exchange should be merged,  and plan participation by December 23, 2011.

• $1 million Planning Grant

• $27,186,749 Level One Establishment Grant

• $123,048,693 Level Two Establishment Grant
• Maryland received the "Early Innovator" cooperative agreement. Award Amount: $6,227,454 

MASSSACHUSETTS Health Connector
Chapter 58 of the Acts of 2006

• Declaration Letter
• Conditional Approval from HHS

(Operational)
Independent State Agency

11 member board 

Click here for  a complete list of board members.

 Active Purchaser

In 2006, Massachusetts passed health reform legislation that required the creation of an exchange.

• The Connector serves many functions and manages two health insurance programs: Commonwealth Care and Commonwealth Choice. Commonwealth Care is a subsidized program for adults who do not have employer-sponsored insurance. Commonwealth Choice offers commercial insurance plans for individuals ineligible for care as well as small business employers.
• Annual Reports are provided to the Legislature.

• $1 million Planning Grant
• A $25 million appropriation from the state general fund helped start the exchange.
• $11,644,938 First Level One Establishment Grant
• $41,679,505 Second Level One Establishment Grant
• Massachusetts was among the consortia of New England states to receive the "Early Innovator" cooperative agreement. Administered by the University of Massachusetts Medical School.
  Award Amount: $35,591,333

MISSISSIPPI

• Awaiting HHS conditional approval, blueprint submitted by insurance commissioner.

On November 14, 2012, Mississippi Commissioner of Insurance, Mike Chaney declared the state's intention to establish a state-based exchange to the U.S. Department of Health and Human Services.

Mississippi announced that its high-risk pool program, the Mississippi Comprehensive Health Insurance Risk Pool Association, will establish the state’s health insurance exchange. The independent, not-for-profit association was created in 1991 to operate the state’s high- risk pool– an insurance program that provides coverage for people who want to purchase insurance but cannot obtain it because of health conditions. Mississippi’s Insurance Commissioner Mike Chaney asked the Association to consider establishing and operating Mississippi’s health insurance exchange, and in May 2011 it agreed to do so.
In 2011, HB 377 extended the operation and reporting deadlines of the Health Insurance Exchange Study Committee, created by law in 2010, allowing continuation until July 1, 2014. The panel will examine issues related to exchanges including the effects on insurance carriers, populations needing coverage, its ability to reduce the number of uninsured, projected costs, and models from other states.

• $1 million Planning Grant

• $20,143,618 Level One Establishment Grant

MISSOURI

Senate Rule 31

On November 6, 2012 voters passed "Proposition E"  changing the state law state law change,"Prohibiting a State-Based Health Benefit Exchange." 
Missouri did not pass establishment legislation during the 2011 legislative session, however, the Senate established the Senate Interim Committee on Health Insurance Exchanges to study the establishment of a state-based health insurance exchange.

In addition to the Senate Interim Committee, the Missouri Health Exchange Coordinating Council (created by the governor), has pursued planning efforts. The Missouri Health Insurance Pool is administering the state's level one establishment grant.

• $1 million Planning Grant 

• $20,865,716 Level One Establishment Grant

   

MONTANA

2011 Joint Resolution  33

In 2011, the legislature enacted a joint resolution creating a interim study committee to examine the feasability and options of establishing a state-based health insurance exchange. The committee will report recommendations back to the 2012  legislature.

• $1 million Planning Grant

NEVADA
2011 SB 440 Chapter No. 439

• Declaration Letter
• Conditional Approval from HHS

Independent State Agency

 10 member board

Click here for a list of board members.

The board will determine in its operational plan.

The Silver State Health Insurance Exchange produced its first year end report in 2011.

The Silver State Health Insurance Exchange Web Site is available.

• Conflict of Interest: Board member cannot be affiliated with insurance carriers or be a legislator.
• Required to submit annual reports to the Governor and the Legislature.

• $1 million Planning Grant

• $4,045,076 First Level One Establishment Grant

• $15,295,271 Second Level One Establishment Grant

• $4,397,926 Third Level One Establishment Grant
• $50,016,012  Level Two Establishment Grant

NEW HAMPSHIRE

 On June 18, 2012, New Hampshire’s legislature passed HB 1297,addressing the state’s role in a federally facilitated exchange while prohibiting the state or anyone in it from creating a state exchange.
 

• $1 million Planning Grant (Returned portion of the grant)

NEW JERSEY

On October 18, the legislature passed the New Jersey Health Benefit Exchange Act (SB 2135), which establishes a health insurance exchange as outlined in the federal health reform legislation. The bill was vetoed by Governor Chris Christie on December 6, 2012. This is the second time this year New Jersey’s legislature passed a bill establishing an exchange. Governor Chris Christie vetoed the previous bill in May, citing the then-outstanding ruling on PPACA from the Supreme Court.

• Planning Grant: $1 million ($223, 186 supplement on 12/2011)
• $7,674,130 Level One Establishment Grant

NORTH CAROLINA
2011 HB 22
Session Law No. 2011-391

On November 15, 2012, Governor Perdue announced that the state will have a partnerhsip exchange.
In 2011, this bill established the General Assembly’s intent to develop a Health Benefit Exchange. Section 49 gives the NC Department of Insurance (DOI) and the NC Department of Health and Human Services (DHHS) the authority to contract with experts to develop the necessary information technology (IT) needed to fulfill the requirements of the ACA. Establishment Legislation (HB 115) did not pass in 2011, but North Carolina is a 2011-2012 carry-over state.

The Department of Insurance continues to plan a state-run exchange. The Department of Insurance identified subcontractors to analyze various exchange implementation scenarios. In addition, the North Carolina Institute of Medicine includes the Health Benefit Exchange and Insurance Oversight Workgroup as part of a health reform oversight committee will provide recommendations to the general assembly and the state departments involved in various functions of the exchange.

• $1 million Planning Grant

• $12,396,019

  Level One Establishment Grant

NORTH DAKOTA
2011 HB 112

As of November 20, 2012, Governor Jack Dalrymple has not made a formal announcement or provided declaration letter. The governor has stated in various media outlets that the state will have a federally-facilitated exchange for now.
In 2011, the legislature passed a law that requires the exchange to be further examined to determine its establishment no later than January 1, 2013 and operational by January 1, 2014. North Dakota’s Insurance Commissioner and the department of human services may adopt rules necessary or desirable to carry out the provisions necessary to establish a health insurance exchange that are stipulated in the law.

The commissioner and department of human services must provide a update to legislative management about their progress before October 15, 2012. A special legislative session will likely be called to consider their recommendations and to take further steps to implement the health benefits exchange. 

North Dakota introduced HB 1474a during the 2011 Special Session that would establish a state exchange. The special session begin the week of November 7, 2011. The bill did not pass the House during the special session which adjourned on November 10, 2011.

• $1 million Planning Grant

OREGON
2011 SB 99, Chapter 415

• Declaration Letter
• Conditional Approval from HHS

Independent Public Corporation of the State

9 member board, 2 ex-officio members

Governor John Kitzhaber has appointed the exchange board members.  

Active Purchaser 

In October 2012, launched Cover Oregon, its official name, logo and website.

Click here to visit Oregon's Health Insruance Exchange Web Page.

In March 2012, the governor signed HB 4164 approving the Oregon Health Insurance Exchange Business Plan.

• Conflict of Interest: The board is required to maintain a balance of consumer representation and health insurance experts. No more than two members can be affiliated with an insurer or provider.
• The board is required to produce a formal business plan and establish implementation policies.
• The board is required to establish a Consumer Advisory Committee and is allowed to establish other types of advisory committees.
• The exchange is allowed to enter into contracts with certified navigators.

• $1 million Planning Grant
• Oregon received the "Early Innovator" cooperative agreement administered by the Oregon Health Authority
  Award Amount: $48,096,307
• $8,969,600 First Level One Establishment Grant
• $6,682,701 Second Level One Establishment Grant
   

PENNSYLVANIA

On December 12, 2012, Governor Tom Corbett announced that the state will not pursue a state exchange at this time and will default to a federally facilitated exchange. HB 627 and SB 940 are pending in the legislature.

• $1 million Planning Grant
• $33,832,212 Level One Establishment Grant

UTAH Avenue H
HB 133 of 2008
and
HB 188 of 2009

• Declaration Letter
• Conditional Approval from HHS

(Operational)
Existing Agency-Office of Consumer Health Services

Not a set number, can be up to 9 

Not an Active Purchaser, all plans are allowed to participate

• The Exchange is designed to connect consumers to the information they need to make informed health care choices, and in the case of health insurance, to execute that choice electronically.
• The small business portion operates a "defined contribution market" where an employer offers a pre-determined level of funding and allows the employee to purchase their coverage using the funds the employer provided.
• Utah  is modifying the exchange system and expanding its internet portal to meet federal requirements for premium tax subsidies and credits and Medicaid and CHIP eligibility.

•  $1 million Planning Grant

VERMONT
2011 HB 202, Act No. 48

• Declaration Letter
• Conditional Approval from HHS

 Existing Agency

The Deputy Commissioner of the Department of Health Access

Not an Active Purchaser

The intent of the general assembly is to establish the Vermont health benefit exchange in a manner such that it may become the foundation for Green Mountain Care.

• The department of Vermont health access will establish the Vermont health benefit exchange. The Vermont health benefit exchange will be considered a division within the department of Vermont health access and will be headed by a deputy commissioner.
• The Vermont health benefit exchange will establish a navigator program to assist individuals and employers in enrolling in a qualified health benefit plan.

• $1 million Planning Grant

• $18,090,369 Level One Establishment Grant

• $104,178,965 Level Two Establishment Grant
• Vermont was among the consortia of New England states to receive the "Early Innovator" cooperative agreement, administered by the  University of Massachusetts Medical School Award Amount: $35,591,333

VIRGINIA
2011 HB 2434, Chapter No. 823

This bill is intended to establish a state based health insurance exchange. The General Assembly has requested that the Governor, through the Secretary of Health and Human Resources and others, make recommendations regarding a health benefits exchange by the 2012 Session. These recommendations will address, among other things, “the make-up of a governing board for the Virginia Exchange”. The recommendations were provided on November 24, 2011.

• $1 million Planning Grant

WASHINGTON
Chapter 317, Laws of 2011 SB 5445

• Declaration Letter
• Conditional Approval from HHS

Public/Private Partnership separate from the state

11 member board 

Governor Gregoire appointed board members on December 15, 2011.

Board of Directors will decide 

• Conflict of Interest: The board members must not benefit financially from serving on the exchange while on the board.
• The board has to develop an implementation report to be presented to the legislature by 2012.
• The board will decide to whether to establish a SHOP and individual exchange as one or separately.

• $996,285 Planning Grant
• $22,942,671 Level One Establishment Grant
• $127,852,056 Level Two Establishment Grant
   

WYOMING
HB55
Act No. 102

Creates the Wyoming Health Insurance Exchange Steering Committee. The steering committee will conduct a study of whether to create a Wyoming health insurance exchange or participate in a regional exchange. Committee members include policymakers and stakeholders. The steering committee is authorized to contract with experts and consultants in order to conduct their study. A preliminary report is due by October 1, 2011.

• $800,000  Planning Grant

Executive Branch Action

Executive Orders and Executive Branch Agency Actions

ALABAMA
 

On November 13, 2012, Governor Bentley announced that the state will not pursue a state exchange.
The Commission is to study the establishment of the Alabama Health Benefits Exchange and make recommendations to the Governor and Legislature by December 1, 2011. These recommendations are to include the form, governance, resource allocation, function and potential effects of the Exchange. Legislation within the 2012 Regular Session will then consider these recommendations with regards to the creation, governance and implementation of the Alabama Exchange. Introduced legislation in 2012, did not pass.
Governor Robert Bentley created Executive Order 17 on June 2, 2011 to establish the Alabama Health Insurance Exchange Study Commission.

• $1 million Planning Grant
• $8,592,139 Level One Establishment Grant

ALASKA

In July 2012, Governor Sean Parnell announced that Alaska will not create a state-run health insurance exchange under the new federal health care law. His announcement came after the State of Alaska completed a study on health insurance exchange planning.

• The state has not applied for federal funds related to health insurance exchanges.

ARKANSAS¹

• Declaration Letter
• Conditional Approval

Governor Mike Beebe has directed the Arkansas Insurance Department (AID) to lead planning efforts for the establishment of an exchange. The AID received a one year, $1 million planning grant from the United States Department of Health and Human Services to assist with studying options for the development of an exchange. As part of their efforts, the AID established a Health Benefits Exchange Planning website: http://hbe.arkansas.gov/.

• $1 million Planning Grant
• $7,665,483 First Level One Establishment Grant
• $18,595,072 Second Level One Establishment Grant

ARIZONA

On November 28, 2012, Governor Jan Brewer announced that the state will not establish a state exchange.
Governor Jan Brewer established the Office of Health Insurance Exchanges to organize the state's implementation efforts and conduct analysis on the establishment of an exchange in the state.

• $1 million Planning Grant
• $29,877,427 Level One Establishment Grant

DELAWARE¹

• Declaration Letter
• Conditional Approval

Governor Jack Markell submitted a letter to the U.S. Department of Health and Human Services on November 14, 2012, indicating that the state will pursue a state/federal partnership in regards to exchange establishment in the state. Delaware will run the plan management and consumer assistance functions of the federally facilitated exchange.

The Delaware Health Care Commission within the Delaware Health and Human Services serves as the planning group for the state on Health Insurance Exchanges.

• $1 million Planning Grant
• $3,400,096 Level One Establishment Grant

FLORIDA

After the Supreme Court issued an opinion on the Patient Protection and Affordable Care Act, Governor Rick Scott announced that the state will not implement a state health insurance exchange because of the potential rise in cost for health insurance premiums.

• The state has not applied for federal funds related to health insurance exchanges.

GEORGIA
 

On November 16, 2012, Governor Nathan Deal notified U.S. Secretary of Health Kathleen Sebelius in a letter that Georgia will not set up a state-based health insurance exchange.  This means that the state will default to a federally-facilitated exchange.
Past Action: Governor Nathan Deal created an Executive Order on June 2, 2011 to establish the Georgia Health Insurance Exchange Advisory Committee. The Committee is to make preliminary recommendations to the Governor by September 15, 2011 and final recommendations by December 15, 2011. The Executive Order emphasized a desire to “develop an exchange that reflects a free market, conservative approach to expanding health insurance coverage in Georgia”. The Committee is composed of legislators, the Commissioner of Insurance, the Commissioner of the Department of Community Health, the Chief Operating Officer of the Department of Economic Development, and others.

• $1 million Planning Grant

IDAHO¹

• Declaration Letter
• Conditional Approval from HHS

On December 11, 2012, Governor C.L. Otter announced that the state will pursue a state-based exchange.
In November 2012, the governor announced that he would use the extension of decision deadlines to meet with legislative leaders about the establishment of a health insurance exchange. He hopes to make a formal decision by December 14, 2012, the U.S. Department of Health and Human Service's new deadline for submitting a blueprint and declaration for states that wish to operate a state-based exchange.

• $1 million Planning Grant

• $20,376,556  Level One Establishment Grant

INDIANA
 

Although Governor Mitchell Daniels, Jr.  created Executive Order 11-01 to establish the Indiana Health Benefit Exchange, after the November 2012, he sought input from Governor-Elect Mike Pence on exchanges,the governor-elect stated that he will not support the creation of state-based or partnership exchange. It names the Indiana Family and Social Services Administration to work with other state agencies to establish and operate an exchange. It establishes the "Indiana Insurance Market" as a nonprofit corporation. Designates the Secretary of the Indiana Family and Social Services Administration to serve as the incorporator of the exchange. Provides for a board of directors and an appropriation analysis. The establishment of the exchange by executive order may still require legislative action.

• $1 million Planning Grant

• $6.9  Level One Establishment Grant

IOWA

In a letter to U.S. Secretary of Health Kathleen Sebelius, Governor Terry Branstad said that the state will continue to pursue a state-based exchange, despite some questions and concerns about the exchanges. The governor mentioned in the letter that the state may have to default "to some level of a federally-facilitated" exchange if more guidance and additional details are not provided from the federal government.
The Department of Health established an Interagency Planning Workgroup to collaborate between the Iowa Department of Public Health, Iowa Department of Human Services (State Medicaid Agency), Iowa Insurance Division, and the Iowa Department of Revenue. The Department will create final recommendations to include: organizational structure for the exchange, implementation plan including policy recommendations and core capabilities, sustainability plan, comprehensive plan for implementation, expansion of stakeholder input, and coordinate planning efforts with existing state and federal programs. They will also assess needed resources and regulations.

• $1 million Planning Grant
• $7,753,662 First Level One Establishment Grant
•  $26,623,003 Second Level One Establishment Grant

KANSAS

On November 8, 2012, Governor Brownback announced that the state will not participate in implementing a state or partnership exchange.
2011- Insurance Commissioner Sandy Praeger requested a steering committee charter to make recommendations to the Department of Insurance regarding the planning and development of a Kansas Health Benefit Exchange. In addition, eight planning workgroups comprised of citizens across the state report to the steering committees on issues related to their specific workgroup topic. The planning work done by the Department of Insurance is supported by the governor and workgroups continue to meet.

• $1 million Planning Grant

• Received $31.5 million in Early Innovator IT Grant, however, the grant was returned in August 2011.

KENTUCKY¹

• Declaration Letter
• Conditional Approval from HHS

Kentucky Governor Steve Beshear issued an Executive Order establishing the Office of the Kentucky Health Benefit Exchange, which will oversee the implementation and operations of the Exchange. The office will be housed in the Cabinet for Health and Family Services. The governor made his intentions to establish an exchange very clear in early May, when he stated that if the court upheld the Patient Protection and Affordable Care Act, he preferred to take the advice of many stakeholders and create an exchange run by the state.

• $1 million Planning Grant

• $7,670,803 First Level One Establishment Grant

• $57,896,810 Second Level One Establishment Grant
• $4,423,000 Third Level One Establishment Grant

LOUISIANA

In March 2011, Governor Bobby Jindal announced that Lousiana would return planning grant funds and the state will not establish a state exchange. Legislation was introduced in 2011 and 2012, but failed both sessions.

• $1 million Planning Grant (returned)

MAINE

In a letter to U.S. Secretary of Health Kathleen Sebelius on November 16, 2012, Governor Paul LePage wrote that the state will not establish a state-based health insurance exchange.
In April 2012, Governor Paul LePage stated that Maine will not use the Level One Establishment grant awarded to the state and that the state will not establish a state-based exchange. Click here to view 2011 legislative action in Maine.

• $1  million Planning Grant
• $5,877,676 Level One Establishment Grant

• Maine was among the consortia of New England states to receive the "Early Innovator" cooperative agreement, administered by the  University of Massachusetts Medical School
  Award Amount: $35,591,333

MICHIGAN

Governor Rick Synder announced that the state will pursue a state/federal parternship exchange, unless the legsilature approves pending legislation to establish a state exchange or HHS extends the deadlines for the state-run exchanges.

• $999,772 Planning Grant

• $9,849,305 Level One Establishment Grant

MINNESOTA¹

• Declaration Letter
• Conditional Approval from HHS

In July 2012, Governor Mark Dayton submitted a letter to U.S. Secretary of Health and Human Services Kathleen Sebelius stating the intention of the state to move towards a state-run health insurance exchange.

The Department of Commerce Commissioner Mike Rothman with the support of Governor Mark Dayton announced the establishment of the Health Insurance Exchange Advisory Task Force to advise on the development and operation of a state-based health insurance exchange.  

• $1 million Planning Grant 

• $4,168,071 First Level One Establishment Grant

• $26,148,929 Second Level One Establishment Grant
• $42,525,892 Third Level One Establishment Grant

NEBRASKA

Governor Dave Heineman announced on November 15, 2012 that the state would have a federally facilitated exchange.

NEW MEXICO¹

• Declaration Letter
• Conditional Approval from HHS

Despite earlier objections to a state-run health insurance exchange, Governor Susana Martinez's administration has moved ahead with exchange planning in the state, using federal funds to contract with vendors and consultants. As of November 20, 2012, the governor had not made a formal declaration, however, local media outlets are reporting that the administration is moving forward with a state exchange. Please check back for updates.
In 2011, New Mexico's legislature passed a bill that was vetoed by the governor.

• $1 million Planning Grant
• $34,279,483 in Level One Establishment Grant

• Declaration Letter
• Conditional Approval from HHS

Governor Andrew Cuomo established the New York Health Benefit Exchange through an Executive Order 42 on April 12, 2012. The executive order requires the exchange to be financially self sustaining by 2015, and take advantage of the federal funds that are available through 2014. The governor’s order does not set up a formal governing board. Instead it allows for stakeholder and public comment through regional advisory committees made up of consumer advocates, small business representatives, health care providers, agents, brokers, insurers, labor organizations and others. These groups will advise the Department of Health and make recommendations on the establishment and operation of the exchange. The Department of Health will house the exchange.

• Planning Grant: $1 million

• $10,774,898 First Level One Establishment Grant
• $48,474,819 Second Level One Establishment Grant
• $95,496,490 Third Level One Establishment Grant
• Early Innovator IT Grant: $27,431,432

OHIO

On November 16, 2012, Governor John Kasich informed the U.S. Department of Health and Human Services that the state will have a federally-facilitated exchange at this time.

• $1 million Planning Grant

OKLAHOMA

On November 19, 2012 Governor Mary Fallin sent a letter to U.S. Secretary of Health and Human Services Kathleen Sebelius informing her of the state's exchange decision not to create a state-run health insurance exchange. The state will have a federally-facilitated exchange.
In 2011, the Oklahoma Legislature established the Joint Committee on the Federal Health Care Law to examine what options the state has in implementing all or certain parts of the Affordable Care Act. The committee's final recommendations included establishing a non-compliant (does not meet all federal requirements in the law) exchange.

• $1 million Planning Grant

• Received $54.6 million in Early Innovator IT Grant, however, the grant was returned in April 2011.

RHODE ISLAND¹

• Declaration Letter
• Conditional Approval from HHS

Governor Lincoln Chafee signed Executive Order 2011-09 which establishes the Rhode Island Health Benefits Exchange as a division within the Executive Department.  A 13 member board will govern the exchange, the board is allowed to determine which health plans will be allowed in the exchange. The executive order also states that the state exchange:

• Must meet all minimum requirements set by the Affordable Care Act.
• Conflict of Interest: Board members cannot be affiliated with any insurer, agent, broker or provider.
• Also allows for the establishment of advisory committees.
• The exchange contracts with carriers and determines which insurers are allowed to participate, given they meet the minimum federal requirements.

• $1  million Planning Grant
• $5.2 million Level One Establishment Grant
• $9,667,964 Level Two Establishment Grant

• Rhode Island was among the consortia of New England states to receive the "Early Innovator" cooperative agreement, administered by the  University of Massachusetts Medical School
  Award Amount: $35,591,333

SOUTH CAROLINA
 

In July 2012, Governor Nikki Haley issued a letter stating that South Carolina will not create a state exchange or accept establishment grants from the federal government. The letter stated that the decision is based on a study done by the state researching exchanges.
In 2011, Governor Nikki Haley established the South Carolina Health Exchange Planning Committee through Executive Order 2011-09. The Committee shall be an advisory group whose mission is to assist with research as determined necessary by the Director of Insurance and to provide recommendations on the health insurance exchange planning process as described in the Exchange Planning Grant application. If the committee recommends a state-based exchange, it must include detailed recommendations regarding the structure, governance, etc. of the exchange.

• $1 million Planning Grant 

SOUTH DAKOTA

In September 2012, Governor Dennis Daugaard announced that the state will not develop a state exchange.
Prior to this decision, Governor Daugaard elected to develop a large taskforce similar to prior stakeholder groups assembled in South Dakota to address both coverage for the insured and the development of recommendations for the state’s long term care delivery system. This task force will have several subgroups to focus on areas such as operations and financing an exchange, outreach and communication, and insurance plan and market organization. Lt. Governor Matt Michels will serve as chairman of the group. Representation has been sought and received from small businesses, insurance agents, insurance companies, health care providers, consumer advocates, state agencies, and state legislators.

•  $1 million Planning Grant

• $5,879,569 Level One Establishment Grant
   

TENNESSEE

Tennessee’s Benefits Administration and the Department of Finance has taken the lead on planning for the health insurance exchange in the state. The Department has identified subcontractors to work with through March 31, 2013 to analyze various aspects of a state based health insurance exchange.  

Additionally, the Benefits Administration and the Department of Finance established the Tennessee Planning Initiative for the PPACA Health Insurance Exchange . The goals of the Initiative are to identify key decision points, research policy alternatives and make recommendations on health care. The Initiative is working with a variety of stakeholders and has convened two Technical Assistance Groups (TAGs) to determine whether the state should operate an insurance exchange, and, if so, how it should be structured. Members of the Agent/Broker TAG and Actuary/Underwriter TAG will provide expertise and contribute to the analysis and the planning process.

• $1 million Planning Grant

• $1,560,220 First Level One Establishment Grant

• $2,249,945 Second Level One Establishment Grant

• $4,300,000 Third Level One Establishment Grant 

   

TEXAS

In July 2012, Governor Rick Perry issued a letter to the U.S. Department of Health and Human Services Secretary Kathleen Sebilius stating that Texas will not create a state exchange or implement optional parts of the federal health law.
The Texas Department of Insurance (TDI) and the Texas Health and Human Services Commission (HHSC) are coordinating planning efforts.

• $1 million Planning Grant

In reaction to the Supreme Court ruling, Governor Scott Walker issued a statement declaring that he will not implement any part of the federal health law.
On January 18, 2012 Governor Scott Walker announced he will return $37.6 million in Early Innovator Grant program funding to the federal government.
In 2011, Governor Scott Walker established the Office of Free Market Health Care which is to be directed by the Department of Health Services and the Office of the Commissioner of Insurance to develop and recommend a plan that encourages competition through the leveraging of a free-market approach based on a set of requirements outlined in the executive order. 
 

• $1 million Planning Grant
• Wisconsin received the "Early Innovator" cooperative agreement. 
  Administered by the Wisconsin Department of Health Services
  Award Amount:  $37,757,266 (Returned $37.6 million)

WEST VIRGINIA 
 

Although West Virginia passed HB 408, Act No. 100 in 2011 it was not implemented due to financial concerns of establishing a state exchange. As a result, the state did not pursue a state exchange by the Dec. 14, 2012 deadline. The governor has announced that the state will likely pursue a state/federal partnership. If the state decides to continue the pursuit of a partner exchange with the federal government it must submit a blueprint (state plan) for approval from HHS by Feb. 15, 2013.

• $1 million Planning Grant
• $9,667,694 in Level One Establishment Grant