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State Decisions on Health Insurance Exchanges and the Medicaid Expansion, as of September 16, 2013

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Location

Status of State Exchange Decision

Current Status of Medicaid Expansion Decision

United States

17 Declared State-based Exchange; 7 Planning for Partnership Exchange; 27 Default to Federal Exchange

26 Moving Forward at this Time; 22 Not Moving Forward at this Time; 3 Debate Ongoing

Alabama

Default to Federal Exchange

Not Moving Forward at this Time

Alaska

Default to Federal Exchange

Not Moving Forward at this Time

Arizona

Default to Federal Exchange

Moving Forward at this Time

Arkansas

Planning for Partnership Exchange

Moving Forward at this Time1

California

Declared State-based Exchange

Moving Forward at this Time

Colorado

Declared State-based Exchange

Moving Forward at this Time

Connecticut

Declared State-based Exchange

Moving Forward at this Time

Delaware

Planning for Partnership Exchange

Moving Forward at this Time

District of Columbia

Declared State-based Exchange

Moving Forward at this Time

Florida

Default to Federal Exchange

Not Moving Forward at this Time2

Georgia

Default to Federal Exchange

Not Moving Forward at this Time

Hawaii

Declared State-based Exchange

Moving Forward at this Time

Idaho

Declared State-based Exchange3

Not Moving Forward at this Time

Illinois

Planning for Partnership Exchange

Moving Forward at this Time

Indiana

Default to Federal Exchange

Not Moving Forward4

Iowa

Planning for Partnership Exchange

Moving Forward at this Time1

Kansas

Default to Federal Exchange5

Not Moving Forward at this Time

Kentucky

Declared State-based Exchange

Moving Forward at this Time

Louisiana

Default to Federal Exchange

Not Moving Forward at this Time

Maine

Default to Federal Exchange5

Not Moving Forward at this Time

Maryland

Declared State-based Exchange

Moving Forward at this Time

Massachusetts

Declared State-based Exchange

Moving Forward at this Time

Michigan

Planning for Partnership Exchange

Moving Forward at this Time1

Minnesota

Declared State-based Exchange

Moving Forward at this Time

Mississippi

Default to Federal Exchange6

Not Moving Forward at this Time

Missouri

Default to Federal Exchange

Not Moving Forward at this Time

Montana

Default to Federal Exchange5

Not Moving Forward at this Time2

Nebraska

Default to Federal Exchange5

Not Moving Forward at this Time

Nevada

Declared State-based Exchange

Moving Forward at this Time

New Hampshire

Planning for Partnership Exchange

Debate Ongoing2

New Jersey

Default to Federal Exchange

Moving Forward at this Time

New Mexico

Declared State-based Exchange7

Moving Forward at this Time

New York

Declared State-based Exchange

Moving Forward at this Time

North Carolina

Default to Federal Exchange

Not Moving Forward at this Time

North Dakota

Default to Federal Exchange

Moving Forward at this Time

Ohio

Default to Federal Exchange5

Debate Ongoing

Oklahoma

Default to Federal Exchange

Not Moving Forward at this Time

Oregon

Declared State-based Exchange

Moving Forward at this Time

Pennsylvania

Default to Federal Exchange

Moving Forward at this Time1

Rhode Island

Declared State-based Exchange

Moving Forward at this Time

South Carolina

Default to Federal Exchange

Not Moving Forward at this Time

South Dakota

Default to Federal Exchange5

Not Moving Forward at this Time

Tennessee

Default to Federal Exchange

Debate Ongoing1

Texas

Default to Federal Exchange

Not Moving Forward at this Time

Utah

Default to Federal Exchange8

Not Moving Forward at this Time

Vermont

Declared State-based Exchange

Moving Forward at this Time

Virginia

Default to Federal Exchange5

Not Moving Forward at this Time

Washington

Declared State-based Exchange

Moving Forward at this Time

West Virginia

Planning for Partnership Exchange

Moving Forward at this Time

Wisconsin

Default to Federal Exchange

Not Moving Forward at this Time

Wyoming

Default to Federal Exchange

Not Moving Forward at this Time

 

Notes

Data are as of September 16, 2013. It is important to note that per CMS guidance, there is no deadline for states to implement the Medicaid expansion. Requirements for legislation to implement the Medicaid expansion vary across states; some state will require authorizing language and/or budgetary authority to implement the expansion while others will not.

Coverage through the exchanges will begin in every state on January 1, 2014, with enrollment beginning October 1, 2013. States can elect to build a fully state-based exchange, enter into a state-federal partnership exchange, or default into a federally-facilitated exchange. The Affordable Care Act (ACA) directs the Secretary of Health and Human Services (HHS) to establish and operate a federally-facilitated exchange in any state that is not able or willing to establish a state-based exchange. In a federally-facilitated exchange, HHS will perform all exchange functions. States entering into a state-federal partnership exchange may administer plan management functions, in-person consumer assistance functions, or both, and HHS will perform the remaining exchange functions.

The ACA expands Medicaid coverage for most low-income adults to 138% of the federal poverty level (FPL) ($15,415 for an individual or $26,344 for a family of three in 2012). Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. For additional information on the cost and coverage implications of the Medicaid expansionsee the following KCMU resources: The Cost of Not Expanding Medicaid (July 2013) and Analyzing the Impact of State Medicaid Expansion Decisions (July 2013).

Sources

Exchange Decisions: Data compiled through review of state legislation and other exchange documents by the Kaiser Family Foundation. For more detailed descriptions of states’ health insurance exchange planning and implementation efforts, please visit State Exchange Profiles.
Current Status of Medicaid Expansion Decisions: Based on KCMU analsyis of recent news reports as well as executive and legislative activity in states.

Definitions

Declared State-Based Exchange: State has indicated that it will establish a state-based exchange.
Planning for Partnership Exchange: State has indicated that it will partner with the federal government to operate an exchange. Default to Federal Exchange: State has indicated that it will default to a federally-facilitated exchange.

Footnotes
  1. Exploring an approach to Medicaid expansion likely to require waiver approval.
  2. Discussion of a special session being called on the Medicaid expansion.
  3. Idaho received conditional approval from HHS to run a state-based exchange. However, due to time constraints in implementing an IT system, the Idaho Health Insurance Exchange Board voted to work with the federal government in running the individual and SHOP exchange until their IT platform is fully developed. The state will maintain plan management and consumer assistance functions, while the federal government will operate the IT system.
  4. On September 3, 2013, Indiana received approval for a one-year extension of its existing 1115 waiver program, the Healthy Indiana Plan (HIP).
  5. Seven states, Kansas, Maine, Montana, Nebraska, Ohio, South Dakota, and Virginia have received approval from HHS to conduct plan management activities to support certification of qualified health plans in the federally-facilitated exchange.
  6. On November 14, 2012, Mississippi's elected Commissioner of Insurance Mike Chaney submitted a blueprint application to HHS indicating the state's intent to establish a Health Insurance Exchange. However, Governor Phil Bryant opposed the establishment of a state-based exchange and on February 7, 2013, HHS rejected the state's application.
  7. New Mexico received conditional approval from HHS to run a state-based exchange. However, due to time constraints in implementing an IT system, the New Mexico Health Insurance Exchange Board voted to work with the federal government in running the individual exchange until October 2014. The state will maintain plan management and consumer assistance functions, while the federal government will operate the IT system. The state will run the SHOP exchange.
  8. On May 10, 2013, in a letter to Governor Governor Gary Herbert, HHS announced that it will operate a federally-facilitated individual exchange in Utah and will permit the state to operate the small business, or SHOP, exchange.
Posted 4:18 PM  View Comments

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