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Delaware Health Exchange Profile


Establishing the Exchange

In July 2012, Governor Jack Markell (D) indicated that Delaware would begin planning for a state-federal partnership exchange. Delaware will retain plan management and consumer assistance functions, and defer other exchange management functionality to the federal government.

The Delaware Health Care Commission, housed within the Department of Health and Social Services, leads the process of planning for an exchange in Delaware. The Commission, originally created in 1990 with the goal of improving the provision of health care for residents of Delaware, includes 10 members representing the executive and legislative branches of government and public and private sectors. The Commission also works with the Governance and Policy Subcommittee of the Health Care Reform Steering Committee, which was created in 2010 within the Department of Health and Social Services to implement health reform within the state.

Contracting with Plans: In September 2012, the Health Care Reform Steering Committee and Department of Insurance developed recommendations for state-specific certification standard of qualified health plans (QHPs). Stakeholders submitted comments on the draft QHP standards and the Health Care Commission approved the QHP certification standards on November 1, 2012. The approved standards include: network adequacy standards aligned with standard used for Medicaid and the Department of Public Health; transition plans to support continuity of care for consumers moving between a QHP and Medicaid; quality improvement strategies for participating issuers, such as submitting data to the Delaware Health Information Network (DHIN); and requiring participating issuers to offer at least one bronze-level plan.

Risk Adjustment, Reinsurance, and Risk Corridors: Delaware anticipates that the federal government will administer the state’s reinsurance program.

Consumer Assistance and Outreach: Delaware plans to select and train marketplace assistors in early 2013. The marketplace assistors will act as the main outreach point to communities and the state will monitor and evaluate them on an on-going basis. Delaware received public comment on proposed certification standards for applicants to the marketplace assistor program and revised its standards based on stakeholder response. Current draft requirements include that applicants commit to training after initial certification and that they cannot be employed by an insurer and must disclose any compensation received from plans in the previous 24 months. The Health Care Commission plans to release an RFP for marketplace assistor organizations in January 2013.

Small Business Health Options Program (SHOP) Exchange: In March 2012, a subcontractor provided Delaware with an assessment of the impact of merging the small group and individual markets. The analysis found that merging the two markets would increase premium rates for current individual enrollees and small group premiums. However, there are considerations besides cost, such as sustainability and stability of the exchange. An alternative strategy offered by the subcontractor would be to keep the individual and small group markets separate but implement similar requirements, such as mandating that all QHPs participate in both markets or requiring plan standardization.

Coordination with Medicaid/CHIP: Delaware intends to retain the authority to make final eligibility determinations for Medicaid and the Children’s Health Insurance Program (CHIP) for individuals that apply directly through the Exchange.

Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Delaware selected the Blue Cross Blue Shield Small Group EPO as the benchmark plan. Delaware will supplement the benchmark plan with the Federal Employee’s Dental and Vision Insurance Program for pediatric dental and vision services. In addition, Delaware adopted the standard requiring habilitative services to be offered at parity with rehabilitative services.

Exchange Funding

The Delaware Department of Health and Social Services received a federal Exchange Planning grant of $1 million in 2010. In November 2011, Delaware was awarded a Level One Establishment grant for $3.4 million to ready business and information technology systems for an exchange. Delaware received a second Level One Establishment grant for $8.5 million in January 2013 to support the review of qualified health plan (QHP) applications, to implement a consumer assistance program, and to fund an outreach and education campaign.

Next Steps

On December 20, 2012, Delaware received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a partnership exchange. Final approval is contingent upon the state demonstrating its ability to perform all required Exchange activities on time; complying with future guidance and regulations; signing a memorandum of understanding with CMS outlining the roles and responsibilities for the state’s operation of plan management, consumer assistance, outreach and education functions; and obtaining the appropriate authorities to enforce all ACA health insurance market reforms.

Additional information about the Delaware exchange planning process and the Commission’s activities can be found at:

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