Iowa Health Exchange Profile
Establishing the Exchange
On December 14, 2012, Governor Terry Branstad (R) informed federal officials that Iowa would pursue a state-federal partnership health insurance exchange. A state opting for a partnership exchange can choose to operate plan management functions, consumer assistance functions, or both. A state can also elect to perform Medicaid and Children’s Health Insurance Program (CHIP) eligibility determinations or use federal government services. Iowa will assume plan management functions in the Exchange and will continue to perform Medicaid and CHIP eligibility determinations. The state intends to transition to a fully state-based exchange in 2015.
Prior to the decision to pursue a partnership exchange, the Iowa Department of Public Health, collaborating with the Insurance Division, the Department of Human Services, and the Department of Revenue, formed a Health Benefit Exchange Interagency Workgroup. In 2011, the Workgroup hosted a series of regional discussions with consumers, providers, insurance agents, business owners, and policy makers to gather public comments regarding the state’s development of an exchange and released a final report on the findings in June 2011. Workgroup representatives met with legislators and the Governor to provide updates on the exchange planning work being done in the state.
Contracting with Plans: The Iowa Insurance Department (IID) will be responsible for Qualified Health Plan (QHP) certification and will use the System for Electronic Rate and Form Filing (SERFF) to facilitate the process. Issuers will use SERFF to submit QHP-specific rate and benefits data, which will be reviewed by IID to determine whether the QHP is compliant with certification standards. IID will then send its recommendations for final certification to the Center for Consumer Information and Insurance Oversight (CCIIO). IID intends to submit all QHP recommendations to CCIIO by June 21, 2013 and issuers will load QHP data into the federally-facilitated exchange (FFE) in July and August. IID will monitor plan management activities to ensure that QHPs meet quality and performance expectations and will partner with CCIIO to determine the best means of displaying QHP quality reporting to consumers. IID will also perform reviews of form and rate filings, network adequacy, and accreditation, licensure, and solvency standards. Iowa will not require plan standardization.
Consumer Assistance and Outreach: In May 2012, Governor Branstad signed HF 2645 establishing licensing requirements and criteria for Navigators to be determined by the Insurance Commissioner. Iowa hired a subcontractor in November 2012 to examine design options for an Iowa Navigator Program and to develop a timeline for program implementation.
Small Business Health Options Program (SHOP) Exchange: In November 2012, the state commissioned a report to review the statutory, regulatory, and administrative SHOP exchange requirements and to discuss major design and procurement decisions. The report recommends engaging stakeholders in the small group market as a next step towards developing a specific SHOP exchange design.
Information Technology (IT): The Department does not believe Iowa’s current eligibility system can be modified to meet the requirements of the ACA and identified a significant need for IT investment. In September 2012, the Department hired a contractor to develop a new Medicaid and Children’s Health Insurance Program (CHIP) eligibility system that will have exchange interoperability. The initiative, called the Eligibility Integrated Application Solution (ELIAS) project, will provide real-time eligibility determinations for a number of public assistance programs and will eventually replace the current system. Iowa intends for ELIAS to interface with the federal data hub to acquire the necessary information for eligibility determination for Modified Adjusted Gross Income (MAGI) Medicaid/CHIP beneficiaries. ELIAS will also interface with the FFE by sending and receiving consumer account information; however this relationship will discontinue when Iowa transitions to a state-based Exchange. ELIAS is a Commercial Off-The-Shelf (COTS) system and is currently in the design phase.
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through an exchange, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. Since Iowa has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Wellmark (Blue Cross Blue Shield)- Alliance Select, PPO.
Basic Health Program (BHP) Option: In November 2012, a subcontractor released a report that determined the BHP would cost the state additional funds unless fees equivalent to Medicaid reimbursement levels were paid to providers. The state awaits final rules from CMS for the BHP.
In September 2010, the Iowa Department of Public Health received a federal Exchange Planning grant of $1 million. In November 2011, the Department received a federal Level One Establishment grant of $7.7 million to secure additional staff, identify and begin to establish systems and program capacity, build information technology infrastructure, and initiate a business and operational plan. Iowa received a second Level One Establishment grant for $26.6 million in August 2012, which it planned to use for further development of a new eligibility system. In January 2013, Iowa was awarded a third Level One grant for $6.8 million to develop a consumer assistance program.
On March 5, 2013, Iowa 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 regulations, and achieving expected milestones.
For more information on Iowa’s health insurance exchange planning visit: http://www.idph.state.ia.us/hcr_committees/health_benefit_exchange.asp and