Exchange Planning and Establishment Grants: Grant Awards List
Find the latest Affordable Insurance Exchange grant information
State Planning Grants: Awarded September 30, 2010
Territory Establishment Grants: Awarded March 21, 2011
State Planning Grants
Awarded September 30, 2010
Alabama
Administrator: Alabama Department of Insurance
Amount Awarded: $1,000,000
- Assess the status of health insurance in Alabama as it relates to the uninsured, the underinsured and the currently insured to determine what the environment will look like in 2014 and what consumer demand for the Exchanges will be.
- Determine the best governance structure for the Exchange.
- Incorporate a broad-based workgroup and working subgroups of interested stakeholders to assist the Department as it envisions an Alabama Exchange.
- Seek appropriate legal and regulatory authority to establish an Exchange.
Arizona
Administrator: Office of the Governor, Arizona Office of Economic Recovery
Amount Awarded: $999,670
- Develop a comprehensive plan for Exchange implementation that ensures a strong competitive marketplace, improves quality and continuity of care so that consumers can seamlessly move from one product to another and ensures that any implementing entity has sufficient flexibility to meet challenging timeframes while maintaining accountability.
- Contract with the Medicaid Division, the Department of Insurance, and the Arizona State University Department of Biomedical Informatics to help plan for an Exchange.
- Convene stakeholders to gather input and leverage existing resources.
Arkansas
Administrator: Arkansas Insurance Department
Amount Awarded: $1,000,000
- The planning process will be guided by principles of consumer protection, stakeholder inclusion, integrated systems, quality, and cost-efficiency.
- Create an interagency executive planning team.
- Secure assistance with research and analyses that will allow Arkansas to make informed planning decisions.
- Create a final report which will include recommendations about:
- Governance and administrator of the Arkansas Exchange.
- Policy/regulatory needs including benefit standards, incentives, reporting, and monitoring requirements.
- Existing technology and infrastructure to support Exchange operations.
- Methods and costs for integrating Exchange eligibility and enrollment processes with those for Medicaid and other emerging health reform initiatives.
- A start-up business/operations plan and five year sustainability plan for Arkansas’s Exchange.
California
Administrator: California Health and Human Services Agency
Amount Awarded: $1,000,000
- Establish an Exchange Board and recruit key staff.
- Analyze the current public and private insurance markets.
- Convene stakeholders and the general public to gather input.
- Develop a multi-year plan for Exchange planning tasks.
- Collect data on the demographics of the current and projected population, profiles of insurance markets offering coverage in California and estimates of how the Affordable Care Act will change the number of uninsured Californians.
Colorado
Administrator: Executive Office of the State of Colorado
Amount Awarded: $999,987
- Create an interagency Exchange board.
- Perform an insurance market and information technology assessment, develop an economic analysis of different options available for the Exchange, and design web services.
- Convene community forums focusing on the development of a health insurance Exchange.
- Establish parameters for and the governance structure of a State Exchange.
Connecticut
Administrator: Connecticut Office of Policy and Management
Amount Awarded: $996,850
- Conduct market research and Information Technology infrastructure assessments to understand the effects and implications of different policy decisions that may direct the implementation strategy.
- Research and analyze existing data and obtain newly-collected data to assess the health insurance market and the uninsured population.
- Conduct economic and actuarial modeling to study various policy issues that would impact the design and implementation of the Exchange.
- Survey the small employer and health insurance markets.
- Assess the impact of insurance reforms on premiums.
- Analyze the local marketplace to determine whether the individual and the small group markets should be combined or separate within the Exchange.
- Analyze the size of the small employer market segment that should start participating in the Exchange (either 1-50 employees or 1-100 employees).
- Determine the advantages and disadvantages of a Connecticut statewide Exchange versus a multi-state Exchange.
- Engage in stakeholder dialogue to ensure an accurate and consistent message is being communicated (includes individuals, employers, providers, legislators, insures, etc.)
- Assess the existing Medicaid system and the interface with the Exchange information technology infrastructure required as well as specifications for the accounting and financial system of the Exchange.
- Develop a financial model to determine administrative fees necessary for financial self –sustainability of the Exchange; and
- Develop legislation to create the governance structure of the Connecticut Exchange.
Delaware
Administrator: Delaware Department of Health and Social Services
Amount Awarded: $1,000,000
- Conduct a planning process involving key stakeholders that will enable the State to make an informed decision concerning the implementation of a Health Benefit Exchange.
- Identify the advantages and disadvantages of implementing a State-run Exchange, a regional Exchange, or an Exchange administered by the federal government.
- Utilize State resources, consultant support, and stakeholder participation to inform decision-making related to the establishment of an Exchange in the State of Delaware.
- Solicit the widest-possible involvement from public and private stakeholders through the development of targeted working groups as appropriate.
- Convene public meetings which will provide a vehicle for both dissemination of information and citizen feedback.
District of Columbia
Administrator: Department of Health Care Finance
Amount Awarded: $1,000,000
- Conduct research and assess the District’s insurance marketplace, identifying coverage gaps.
- Identify requirements for Exchange implementation.
- Conduct an analysis of the viability of available models, including cost-benefit analysis.
- Identify potential Exchange partners.
- Develop policy, operational, and infrastructure recommendations for implementing the Exchange and requisite modifications to the Medicaid and other related public programs.
- Establish implementation timelines and work plans.
- Develop a final report summarizing information and findings resulting from the completion of grant activities.
Florida
Administrator: Agency for Health Care Administration
Amount Awarded: $1,000,000
- Research the estimated number of currently uninsured individuals as well as those entitled to tax credits, cost sharing through the Exchange, those eligible for Medicaid or employer-sponsored coverage.
- Create a Technical Advisory Work Group to assist the implementation of the Exchange and how it will build upon current State and Federal programs.
- Address whether Florida should have its own Exchange, join a regional Exchange or elect to have a Federal Exchange.
- Identify legislative and regulatory needs.
Georgia
Administrator: Governor’s Office of Planning and Budget
Amount Awarded: $1,000,000
- Form an Exchange Work Group to carry out the activities of the Georgia Health Benefit Exchange Feasibility Study. An Exchange Advisory Committee will also be formed with broader representation from key State agencies and stakeholder groups.
- Gather stakeholder input through an advisory committee, large group meetings to educate and inform stakeholders, focus groups, and web-based surveys. Website and email notices will be used to keep stakeholders and the general public informed.
- Determine whether or not Georgia should establish an Exchange and the implications of doing so on insurance markets both in Georgia and nationally.
- Provide recommendations on governance structure and regulatory changes required to establish as Exchange to decision makers.
Hawaii
Administrator: Hawaii Department of Commerce and Consumer Affairs
Amount Awarded: $1,000,000
- Conduct background research on the issues related to developing an Exchange.
- Involve stakeholders in the planning process.
- Examine integration of the Exchange with existing programs.
- Assess resource capabilities.
- Consider the appropriate governance mechanism.
- Determine appropriate accounting and reporting guidelines.
- Determine appropriate technical infrastructure.
- Research business operations including implementation issues.
- Examine regulatory and policy aspects.
- Appoint a task force to discuss the issues concerning implementation of an Exchange and receive and process comments from the public.
Idaho
Administrator: Idaho Department of Insurance
Amount Awarded: $1,000,000
- Conduct background research to establish scope and citizen impact.
- Engage stakeholders and create strategies for continued engagement.
- Evaluate existing government and non-government structures for opportunities to integrate these structures to support an Exchange.
- Assess current and future resource needs and capabilities.
- Create recommendations for governance structures.
- Analyze accounting systems and methods to build on those systems.
- Analyze existing technology, capacity and needed expansion.
- Identify changes needed to existing technology and programs to accommodate the implementation of State Exchange.
- Develop methods and resources needed to manage business operations for an Exchange.
- Identify needed enabling State legislation and regulations.
Illinois
Administrator: Illinois Department of Insurance
Amount Awarded: $1,000,000
- Conduct comprehensive review of the status of health coverage in Illinois.
- Develop structure and timeline for implementation of an Exchange that follows recommendations of Health Reform Implementation Council.
- Assess resources needed for the implementation of an Exchange.
- Confer with State agencies about Exchange infrastructure.
- Involve stakeholders to ensure transparency.
- Draft legislation that will enable an Exchange.
- Perform strategic planning on the operational, financial, technical requirements to sustain an Exchange.
Indiana
Administrator: Governor’s Office of Planning and Budget
Amount Awarded: $1,000,000
- Analyze national data sets including the Current Population Survey, the Behavioral Risk Factor Surveillance System, and the Medical Expenditure Panel Survey. This data will allow the State to construct a picture of the uninsured, project take-up rates for Exchange participants and to estimate the number of participants in grandfathered plans.
- Develop a governance plan for a possible Exchange and reach a conclusion on the governance for a potential Exchange.
- Gain stakeholder input through online surveys and forums.
Iowa
Administrator: Iowa Department of Health
Amount Awarded: $1,000,000
- Establish an Interagency Planning Workgroup to ensure collaboration between the Iowa Department of Public Health, Iowa Department of Human Services (State Medicaid Agency), Iowa Insurance Division and the Iowa Department of Revenue
- Create final recommendations, to include:
- Organizational structure for an insurance Exchange
- Shared vision
- Implementation plan that will include policy recommendations and core capabilities
- Blueprint for outreach efforts
- Sustainability plan that will address critical risk factors that will need to be managed.
- Develop a comprehensive plan for implementation of an insurance Exchange in Iowa.
- Further develop the planning process and expand stakeholder input.
- Assess insurance Exchange options.
- Coordinate planning efforts with existing State and federal programs to ensure integration with an insurance Exchange.
- Assess the capacity and infrastructure required for implementation of an insurance Exchange in Iowa.
- Determine administrative resource needs for implementation of an insurance Exchange.
- Assess infrastructure and regulatory needs.
- Identify transition steps for implementation and sustainability based on recommendation of insurance Exchange structure.
Kansas
Administrator: Kansas Insurance Department
Amount Awarded: $1,000,000
- Assess the health benefits Exchange function, its market potential and identified gaps that could impede viability.
- Initiate an inclusive statewide planning and communications function to foster input and participation.
- Appoint an advisory panel and work groups to coordinate efforts and identify options.
- Design an Exchange model with business rules and a supporting actuarial basis for a viable set of plans and benefits.
- Begin drafting an Exchange charter, governing structure, by-laws, and set of accountabilities.
- Address all major financial factors and cost drivers impacting the viability of an Exchange.
- Discuss infrastructure elements of the Exchange including information technology
Kentucky
Administrator: Cabinet for Health and Family Service
Amount Awarded: $1,000,000
- Create an interagency working group.
- Conduct background research and analysis on the uninsured and insured populations in Kentucky.
- Survey health insurance carriers to determine current plan designs and premium levels in the market place.
- Perform economic and actuarial modeling to project trends of newly insured’s and the impact of merging the individual and small group markets.
- Visit other States with existing Exchanges to obtain detailed information on the benefits and limitations of each Exchange.
Louisiana
Administrator: Louisiana Department of Health and Hospitals
Amount Awarded: $998,416
- Assess governance options for the Exchange.
- Research the legal structure that will be put in place based upon the type of Exchange selected by the State.
- Analyze all rules and regulations issued by HHS relative to the Exchange and their impact on Louisiana.
- Draft any legislation and or regulations relative to the Exchange.
- Circulate drafts of legislation to stakeholders and interested parties for comments prior to the pre-filing date.
- Hold educational seminars and provide to leadership, members and staff of the Louisiana Legislature resources for understanding federal requirements for an Exchange and Louisiana policy makers’ role in the decision making and implementation process to ensure the State’s compliance.
Maine
Administrator: Governor’s Office of Health Policy & Finance
Amount Awarded: $1,000,000
- Continue and complement the current efforts of the Health Reform Steering Committee, comprised of key State officials, and the Advisory Council on Health Systems Development (ACHSD) to provide oversight and stakeholder input on issues related to implementation of the Affordable Care Act.
- Support the development of a detailed implementation plan for the Exchange.
- Create a stakeholder process to answer policy and implementation questions in the areas of program integration, business operations, and technical infrastructure.
- Evaluate and model various options for Maine’s Exchange and develop implementation plan.
Maryland
Administrator: Department of Health & Mental Hygiene
Amount Awarded: $999,227
- Utilize the previously established Maryland Health Care Reform Coordinating Council to outline issues pertaining to: engaging the public, gathering and analyzing public comment, conducting focused research, and developing options for consideration by the Coordinating Council.
- Create an information infrastructure plan that assesses existing information systems, identifies gaps and needs, and proposes strategies to achieve seamless eligibility and enrollment in health coverage.
- Develop an outreach and communications strategy for 2011-2014, including market research to guide the design of the Exchange
- Fund Maryland-specific studies of public and private health insurance coverage and health care expenditures to determine whether to merge the individual and small group markets and whether to provide additional protection against adverse selection, development of governance options for the successful operation of the Exchange, and development of operational plans and a sustainable business model for the Exchange.
- Assess current public sector technological capabilities, current private sector technological capabilities and technology solutions that may be available from the federal government.
- Determine whether the existing public or private sector capacity could be adapted for online public access to facilitate eligibility determination, choice of coverage, application, enrollment, the specific options for connecting an eligibility determination system with other components of the Exchange, and develop an RFP for eligibility system expansion or acquisition.
Massachusetts
Administrator: Division of Insurance
Amount Awarded: $1,000,000
- Identify current Health Connector programs, policies, and practices in need of modification given new national requirements for Exchanges.
- Identify a strategic and operational plan and implementation timeline.
- Conduct research to anticipate changes in sources of insurance coverage before and after 2014, and the size and characteristics of the population served by the State Exchange.
- Engage stakeholders in the discussion of Exchange-related issues
- Collaborate with MassHealth to identify and recommend changes to the existing information technology and operational infrastructure needed to comply with new requirements for Exchange eligibility determinations in 2014.
- Review current cash flow structure and identify changes that may be necessary under national reform.
- Review current products offered through the Connector and how they align with specifications for plan design under national reform.
- Examine statutory and regulatory actions to identify potential needed changes, such as minimum essential coverage requirements, definitions of affordability and exemptions from the individual mandate.
Michigan
Administrator: Department of Community Health
Amount Awarded: $999,772
- Conduct the appropriate research to determine those who are potentially eligible for the Exchange and to determine how the Exchange will impact Medicaid, other public programs, and other State health plans.
- Determine how best to establish the American Health Benefits Exchange and Small Business Health Options Program (SHOP Exchange) in Michigan, considering the needs of and options available to individuals and small groups.
- Implement a plan for stakeholder involvement to determine how Michigan will implement the Exchange.
- Develop an initial plan for integration of applicable State and Federal programs and current State projects.
- Develop a plan for a governance model and structure.
- Develop an initial plan for how the Exchange will manage reporting, accounting, and auditing functions while maintaining transparency.
- Review technical components and interoperability of technology embedded in existing State systems and plan for the introduction of possible new systems necessary to properly run an Exchange.
- Review and determine the necessary State statutory and regulatory changes needed to establish the Exchange options.
Minnesota
Administrator: Minnesota Department of Commerce
Amount Awarded: $1,000,000
- Analyze the requirements, options, and impact of an Exchange, engage stakeholders, analyze program integration, and estimate the upfront and ongoing costs of an Exchange.
- Determine the local market impact of the Affordable Care Act (ACA) and assess the impact of options such as the definition of the small group market, merging of the small group and individual markets, allowing wellness and prevention discounts, methods for risk adjustment, and a Basic Health Plan.
- Engage diverse stakeholder groups to solicit input on Exchange requirements and options. This will include a plan for ongoing stakeholder involvement.
- Evaluate and identify viable business models for integration of existing state programs into the Exchange in order to achieve greater value for consumers. Program integration analysis will focus on streamlining and aligning eligibility for public programs, assessing regulatory simplification, and using cost, quality, and satisfaction information to incent value and competition.
- Build on other states’ Exchange prototypes and standards and for a “proof of concept” request for proposals (RFP) for the development of technical infrastructure options and cost estimates for an Exchange.
- Examine regulatory and legislative issues related to the establishment of an Exchange.
Mississippi
Administrator: Mississippi Insurance Department
Amount Awarded: $1,000,000.00
- Conduct a comprehensive analysis of the health insurance market in Mississippi, including research to determine the number of uninsured in the State, those potentially eligible for the Exchange, those eligible for Medicaid, or those with employer coverage but not currently enrolled.
- Utilize the Mississippi Health Insurance Exchange Study Committee as key stakeholders for involvement in the planning for the design and implementation of an Exchange. Additional stakeholders will be identified and asked to participate in the Committee.
- Determine how the Exchange can work with existing State and Federal programs in order to coordinate eligibility and enrollment with Medicaid, CHIP and other programs.
- Determine governance, implementation, and operation requirements in order to decide whether to create an Exchange at the State, regional, or federal level.
- Identify funding requirements and determine resources to operate the Exchange, including fees that will be required, subsidies and tax credits that could be applied, and an accounting system for financial management and reporting.
- Assess the current technical infrastructure available and determine the required resources needed to develop a web portal and/or call center to meet the increased need for consumer education and participation.
- Determine the need for additional legislation and/or State regulations.
Missouri
Administrator: Missouri Department of Insurance
Amount Awarded: $1,000,000
- Provide a planning and development infrastructure to support launching an insurance Exchange.
- Determine the organizational structure of any such Exchange.
- Explore the establishment of a regional Exchange with neighboring States.
- Compile cost estimates for providing coverage to potential populations and gather health status for such populations
Montana
Administrator: Office of the Commissioner of Insurance and Securities
Amount Awarded: $1,000,000
- Conduct several public processes with Stakeholders Involvement Council including interagency work group for program integrations, information technology staff and public comment opportunities.
- Conduct a demographic scan of current population to ascertain information including insurance and socioeconomic status.
- Assess resources and capabilities such as available staff, contracting, updated software.
- Determine necessary legislation to be implemented when appropriate.
Nebraska
Administrator: Nebraska Department of Insurance
Amount Awarded: $1,000,000
- Develop a list of the stakeholders within the State who will provide input regarding the State’s decision about whether to operate the Exchange, on what basis to operate an Exchange, and planning and implementation of the Exchange.
- Develop a description of how an Exchange would build on and integrate with existing State and Federal programs such as Medicaid and the Children’s Health Insurance Program.
- Assess potential current and future staff levels, contracting capabilities and needs, and information technology for operation of an Exchange.
- Conduct an initial assessment of information technology systems and the need for modifications or new systems to facilitate eligibility and enrollment and other Exchange functions.
Nevada
Administrator: Nevada Department of Health and Human Services
Amount Awarded: $1,000,000
- Assemble information, identify priorities, assess resource needs, and lay the foundation for the development of a fully functioning health insurance Exchange that best meets the needs of Nevadans.
- Conduct background research to better quantify the populations covered by existing and future health insurance programs and to better understand the potential impact on the market with introduction of the Exchange.
- Establish a streamlined eligibility process to serve all applicants for all medical assistance programs.
- Define a governance structure and administrator for the Exchange.
- Catalogue existing resources that may be used to support an Exchange.
- Identify services that will need to be developed and contracted to operate the Exchange.
New Hampshire
Administrator: State of New Hampshire Insurance Department
Amount Awarded: $1,000,000
- Obtain an impact analysis on public sector program costs and effect on the general fund of the State.
- Inform, educate, and involve stakeholders including a utilization assessment.
- Develop a general public education and outreach plan regarding an Exchange.
- Develop a macroeconomic model to predict plan migration, analyze the effect of New Hampshire insurance mandates, and identify and quantify risks of adverse selection and insurance market disturbance.
- Exchange and analysis of budgetary impacts on State as well as appropriate internal and external controls.
- Obtain analysis of current State laws and regulations relevant to Exchange and a summary of policy and legislative recommendations for establishing an Exchange and Affordable Care Act implementation.
New Jersey
Administrator: Department of Banking and Insurance
Amount Awarded: $1,000,000
- Research the number, demographic and health characteristics of New Jersey residents who will be eligible and likely to enroll in Medicaid or FamilyCare and subsidized and unsubsidized Exchange products (through individual and small employer Exchange(s)) in New Jersey.
- Conduct forums and on-line surveys to obtain stakeholder input into the design of Exchange(s) in New Jersey.
- Engage experts in benefit design, building provider capacity to accommodate the anticipated enrollment, transitioning existing Medicaid clients into the Exchange, coordinating with social services programs, and reviewing alternative delivery models.
New Mexico
Administrator: New Mexico Department of Human Services
Amount Awarded: $1,000,000
- Fund a financial modeling tool and report, which will identify the population of affected individuals and employers and project the effect of an Exchange(s) on the marketplace, populations of affected individuals, State expenditures and changes in spending by payer.
- Determine the changed distribution of health insurance coverage by payer and the change in health insurance coverage under all of the federal health care reform measures.
- Study and begin to implement the details of implementing the Exchange(s).
- Provide follow-up research and analyses, as suggested by the direction and inquiries made by the Legislature and the incoming Governor.
- Consider a regional Exchange for group purchasing or collective IT vendor.
New York
Administrator: New York Department of Insurance
Amount Awarded: $1,000,000
- Determine whether its current insurance regulations that go beyond the protections of the Affordable Care Act should be maintained or whether they need to be modified to limit adverse risk selection in the Exchanges.
- Compile and evaluate background research from current research platforms and private funding by January 2011.
- Engage stakeholders in the evaluation, planning and development process throughout the one-year planning period.
- Evaluate the extent to which New York can or should integrate and build on existing programs, as appropriate.
- Identify and utilize existing resources and capabilities, as appropriate, throughout the one-year planning period and determine the need for additional resources.
- Design Exchange governance structure and draft legislation, if required.
- Evaluate financial accounting, auditing, and reporting requirements and potential pathways to securing compliance.
- Identify existing technical infrastructure resources and needs.
- Create business operations plan and policies for Exchange.
- Identify legislation and regulations needed to create, promote, and regulate the Exchange.
North Carolina
Administrator: North Carolina Department of Insurance
Amount Awarded: $1,000,000
- Create an interagency group to work on the planning and establishing a foundation for the feasibility of the establishment of Exchange(s) in North Carolina. An advisory group has already been formed with eight different work groups to focus on different areas.
- Build on the work of its SHAP grant to address the needs of the poor and near-poor.
- Determine if the implementation of NC Fast will have to be reexamined to function and/or interface with the Exchange. North Carolina has undertaken a multi-year program to streamline and combine the eligibility process for many of its income determined social programs.
North Dakota
Administrator: North Dakota Insurance Department
Amount Awarded: $1,000,000
- Estimate the potential design and operational details of Exchange as well as its cost.
- Conduct a financial and structural forecast of technical needs for Exchange.
- Implement necessary legislation that is not already in place and educate North Dakotans on changes.
- Convene stakeholders and experts to gather input.
Ohio
Administrator: The Ohio Department of Insurance
Amount Awarded: $1,000,000
- Coordinate public and stakeholder through a specially constituted task force.
- Inform Ohioans of Exchange planning activities through public notices and Ohio’s health reform website.
- Conduct market analysis, modeling Ohio’s public programs and private insurance markets to provide projections and analysis necessary for planning and implementing an Exchange.
Oklahoma
Administrator: Department of Mental Health & Substance Abuse Services
Amount Awarded: $1,000,000
- Convene a large stakeholder group to establish guiding principles and participate in a decision-making framework process.
- Gather existing research, studies and data on aspects of Oklahoma’s health care system including the uninsured, access to care, public coverage programs, insurance products offered, and insurance market trends and regulations.
Oregon
Administrator: Office for Oregon Health Policy & Research
Amount Awarded: $1,000,000
- Study the feasibility of a public corporation Exchange model, including:
- Using a public comment web-portal and soliciting feedback.
- Guidance from technical assistance work group and consumer advisory group.
- Partnering with nearby States for joint purchasing.
- Create a final operational and technical infrastructure plan.
Pennsylvania
Administrator: Pennsylvania Department of Insurance
Amount Awarded: $1,000,000
- Address Information Technology (IT) needs; including altering their various IT benefit systems (Medicaid, Food Stamps, Exchange) so they have the ability to “talk to each other,” and designing a web-portal that offers a common entry point for consumers.
- Produce a comprehensive report on the insurance market, uninsured populations, various Exchange models, and a cost analysis of program integration.
- Analysis of the steps necessary to integrate public programs and private insurance processes and a cost analysis of such integration.
- Identification of financial, information technology and business operations processes required for implementation of a successful Exchanges.
Rhode Island
Administrator: Office of the Health Insurance Commissioner
Amount Awarded: $1,000,000
- Create anInteragency Task Force to assure activities supported by grant are appropriately coordinated.
- Compare cost and benefit of State run Exchange versus federally run Exchange
- Create an operations plan which provides staffing plan.
- Coordinate eligibility and enrollment with Medicaid.
- Develop a product design and contracting plan.
- Create a data and evaluation plan.
- Put in place information system requirements support.
South Carolina
Administrator: South Carolina Department of Insurance
Amount Awarded: $1,000,000
- Determine the feasibility of establishing a health insurance Exchange or Exchanges in this State in accordance with the provisions of the Affordable Care Act.
- Generate a final report and policy recommendations on the feasibility of establishing as insurance Exchange in South Carolina. The report will set forth:
- The issues associated with the various Exchange options (governance, administration and benefit design); and
- The advantages and disadvantages of each for South Carolina as well as the cost of each option.
South Dakota
Administrator: Office of the Governor
Amount Awarded: $1,000,000
- Determine if the State will choose a State-based Exchange or elect a federally administered Exchange.
- Catalog and review existing data sources to glean pertinent information regarding the uninsured, the insurance market, and small businesses.
- Update a State-specific survey to include:
- The demographics of insured and uninsured populations.
- Eligibility of uninsured for employer based converge or Medicaid and reasons for not enrolling in creditable coverage.
- Eligibility of uninsured for subsidies through the Exchange.
- The marketing methods needed to encourage individuals to purchase insurance through the Exchange.
Tennessee
Administrator: Benefits Administration, Tennessee Department of Finance
Amount Awarded: $1,000,000
- Provide major deliverables include policy briefs, legal analyses and contractor studies, including a study on whether to merge the small group and individual markets.
- Analyze Tennessee’s resources and capabilities, with significant additional time spent on program integration and business operations.
Texas
Administrator: Texas Department of Insurance
Amount Awarded: $1,000,000
- Coordinate Texas’ Exchange planning efforts between the Texas Department of Insurance (TDI) and the Texas Health and Human Services Commission (HHSC).
- Use funds to examine specific circumstances of the State. Texas currently has the highest percentage of uninsured (over 26 percent) of any State in the country, as well as the second highest number of uninsured residents (over 6 million).
- Develop considerations about setting up regional Exchanges within the State
Utah
Administrator: Governor’s Office of Economic Development
Amount Awarded: $1,000,000
- Use grant funds to allow Utah to continue to moving forward on current Exchange efforts.
- Expand the Exchange-research to better target potential consumers.
- Develop web-based tool for eligibility purposes.
- Fund additional and current staff positions.
Vermont
Administrator: Vermont Department of Human Services
Amount Awarded: $1,000,000
- Analyze the current insurance market to determine the quality and type of health insurance coverage, the appropriate regulatory environment for implementing the Exchange, and the potential impacts on the market of various options.
- Assess various Exchange organizational models and the policy and fiscal implications of each, as well as resources needed to operate the Exchange
- Model potential funding mechanisms to achieve Exchange sustainability.
- Develop proposed legislation for the 2011 and 2012 sessions.
Virginia
Administrator: Virginia Department of Medical Assistance Services
Amount Awarded: $1,000,000.00
- Establish task forces in six key areas, Medicaid Reform, Insurance Market Reform and Exchanges, Delivery and Payment Reform, Capacity, Technology, and Purchasers, via the Virginia Health Reform Initiative (VHRI). VHRI has been established within the Office of the Secretary of Health and Human Resources. VHRI Advisory Council members represent leaders from the legislature, health care delivery, health care policy, health insurance, and the business community.
- Provide options on the planning, research, development, and implementation issues on how an Exchange’s governance, financial operations and oversight, and technical infrastructure.
Washington
Administrator: Health Care Authority (HCA)
Amount Awarded: $996,285
- Develop an implementation plan by September 30, 2011.
- Focus on cost containment and quality.
- Conduct IT Infrastructure Review and Assessment – coordinate with requirements and business functions in the Planning Report. In 2011, a technology work plan will supplement the implementation plan.
- Focus on legislation that will likely follow the completion of the implementation plan specifies the intent and legal direction of a State-based Exchange
West Virginia
Administrator: West Virginia Offices of the Insurance Commissioner
Amount Awarded: $1,000,000
- Assess State’s health insurance consumer and business markets using previous demographic surveys.
- Develop an economic assessment of West Virginia health insurance market and determine who will participate in Exchange.
- Develop education and outreach strategy for Exchange project, which will result in education and outreach plan. The plan will help promote the Exchange by providing easily accessible information.
- Assess efficiency and effectiveness of technical capacity of current West Virginia systems to perform technical tasks for the Exchange.
Wisconsin
Administrator: Wisconsin Department of Health Services
Amount Awarded: $999,873
- Design an Exchange that moves beyond an aggregator of health insurance options, to a mechanism that influences how health care is delivered in the State. Application makes clear that Wisconsin sees the Exchange as a “transformative force.”
- Contract to develop a predictive model to measure the impact of the insurance market reforms on Wisconsin, coupled with other requirements of the Affordable Care Act.
- Maintain Exchange resource information on the Office of Health Care Reform web site to allow stakeholders to stay informed and provide input.
- Conduct surveys of the individual, small group, and large group markets, and model and analyze insurance reform impacts to assure clear understanding of Wisconsin’s current and future health insurance landscape.
Wyoming
Administrator: Wyoming Department of Insurance
Amount Awarded: $800,000.00
- Form a Task Force to determine if Wyoming will pursue a State-based Exchange, a regional Exchange, or allow the Federal government to operate an Exchange.
- Develop recommendations as to necessary actions to establish a functioning Exchange as well as propose legislative action if the Governor and Task Force recommend that Wyoming participate in the operation of the State’s insurance Exchange, via a partnership with the University of Wyoming.
Posted: July 29, 2010
*MN awarded February 25, 2011
Territory Establishment Grants
American Samoa
Administrator: American Samoa Government
Amount Awarded: $1,000,000
- Develop an Exchange that will pace new investment and private industry by facilitating the purchase of qualified health plans and development of a Small Business Health Options Program.
- Design the platform and database structure for health insurance policy program development and ensure it is well-maintained and updated.
- Create the needed infrastructure for health plan development.
- Invite, review and secure health insurance plans that meet local needs.
- Develop a process for health plan development, review and monitoring.
- Build a secure, comprehensive data structure to support future data collection activities.
Guam
Administrator: Guam Department of Revenue and Taxation
Amount Awarded: $1,000,000
- Conduct a survey of small businesses to gather the data on insured and uninsured employees including those that might be eligible for the Exchange, and those that are eligible but not enrolled in Medicaid or employer’s coverage.
- Conduct stakeholder outreach to gather input on the construction of an Exchange.
- Evaluate and test the Exchange functions and train staff in all phases of the Exchange functions.
- Formulate and submit a legislation creating a Governance structure.
Puerto Rico
Administrator: Puerto Rico Department of Health
Amount Awarded: $917,205
- Conduct background research about Puerto Rico’s uninsured and underinsured populations and current insurance market to understand the populations to be served by the Exchange.
- Model the potential impact of the Exchange.
- Conduct necessary stakeholder outreach.
- Research, analyze, and make recommendations related to the Exchange’s administrative structure, operations, and integration with existing government agencies and programs.
- Review Puerto Rico’s current capabilities to manage processes such as eligibility and applications, payment of premiums, development of benefit packages, and oversight.
U.S. Virgin Islands
Administrator: Government of the Virgin Islands
Amount Awarded: $1,000,000
- Examine the feasibility of an Exchange, conduct initial Exchange planning, and work toward the establishment of an Exchange.
- Research the Territory’s private insurance market, with the goal of increasing participation in the Exchange by individuals and small employers.
- Conduct stakeholder interviews and focus groups with individuals and employers, with an emphasis on accessing hard-to-reach uninsured individuals.
- Develop a program model for the prospective Exchange and associated subsidies, including an analysis of how best to ensure continuity of coverage.
- Explore Exchange governance models, especially the feasibility of a regional Exchange involving one or more States and/or Territories.
- Determine the statutory and administrative actions within the Territory that are needed to establish the Exchange.
- Conduct a gap analysis to identify needed improvements in information systems in order to implement the Exchange.
- Develop a detailed work plan for Exchange planning and implementation activities, as well as an ongoing analysis of Exchange-related staffing and resources needs.
- Create a report on the detailed findings concerning the actions needed to implement an Exchange under the Affordable Care Act.
Posted: September 30th, 2010
Updated: March 22, 2011