Know the Ropes: Exchange Development Issues for

Kids and Families

Charting the Way: Progress and Priorities for Child and Family Coverage

July 18, 2012

2

Children Parents -

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

9,000,000

Expected Exchange Enrollment, US

Source: Genevieve M. Kenney, et al., Improving Coverage For Children Under Health Reform Will Require Maintaining Current Eligibility Standards For Medicaid And CHIP, Health Affairs, December 2011.

FL

NC

SC

GALATX

AL

AR

KS

OKAZ TN

MS

NVUT

NM

CA

WYID

WA

ORND

SD

NE

MT

MO

IN

MI

WI

IL

ME

OH

KY

HI

AK

WV VA

CTNJ

DEMD

RI

NHVT

DC

MA

CO

IA

NYMN

PA

Where Do States Stand?

States committed to state-based exchange

States committed to partnership exchange

FL

NC

SC

GALATX

AL

AR

KS

OKAZ TN

MS

NVUT

NM

CA

WYID

WA

ORND

SD

NE

MT

MO

IN

MI

WI

IL

ME

OH

KY

HI

AK

WV VA

CTNJ

DEMD

RI

NHVT

DC

MA

CO

IA

NYMN

PA

Exchange Establishment Grants

States that have received exchange establishment grants

5

The Timeline AheadDate Milestone

Oct. 1, 2012 States choose EHB benchmark plan

Nov. 16, 2012 State submits Exchange Blueprint

Jan. 1, 2013HHS (conditionally) certifies exchanges

Oct. 1, 2013 Exchanges begin enrollment

Jan. 1, 2014 QHP coverage begins

6

Exchange Blueprints

State BasedMust detail all

exchange activities

Can use federal services for:• Subsidy

determination• IRR exemption• Risk/reinsurance

Partnership

Must detail Plan Management and/or Consumer Assistance

activities

Can use federal services for:• Medicaid/CHIP

eligibility• Reinsurance

FFENo Application

required, Declaration Letter

requested

Can use federal services for:• Medicaid/CHIP

eligibility• Reinsurance

7

Responderso Sabrina Corlette

o Georgetown University Center on Health Insurance Reforms

o Anna Strongo Arkansas Advocates for Children and Families

o Christina Peterso Children’s Alliance

8

Guest Speakero Yvette Fontenot,

Deputy Directoro HHS Office of

Health Reform

*Maine, Massachusetts, New Jersey, New York, and Vermont required insurers to provide coverage to individuals on a guaranteed basis prior to the Affordable Care Act and, thus, already prohibited the denial of coverage to children under age 19. **Kentucky issued a regulatory order which is binding on all insurers marketing individual health insurance.***Nevada issued a temporary regulation which expired. The state currently has no special rules regarding child-only coverage.****Texas passed a new law allowing the Department of Insurance to adopt rules to “increase the availability of coverage to children younger than 19 years of age” but no new regulations have yet been issued.Source: Authors’ analysis.

Exhibit 1. State Action to Promote the Availability of Child-Only Coverage, as of January 2012

Issued new regulation regarding child-only market

Issued sub-regulatory guidance regarding child-only market

Passed new law regarding child-only market

FL

NC

SC

GA

LATX****

AL

AR

KS

OKAZ TN

MS

NV***

UT

NM

CA

WY

ID

WA

ORND

SD

NE

IN

MT

MO

MI

WI

IL

ME*

OH

KY**

HI

AK

PA

WV VA

CTNJ*

DE

MD

RI

NHVT*

DC

MA*

CO

NY*

IA

MN

Took no official action regarding child-only market

* The Arkansas Plan Management Advisory Committee has selected the three largest small group plans for benchmarking and referred the final decision regarding which plan to the Insurance Commissioner.

Exhibit 2. Essential Health Benefits Benchmark: State Action, as of May 31, 2012

Conducting analysis (internal or public)

Made a selection

Conducting analysis and seeking public input

FL

NC

SC

GA

LA TX

AL

AR*

KS

OKAZ TN

MS

NV

UT

NM

CA

WY

ID

WA

ORND

SD

NE

IN

MT

MO

MI

WI

IL

ME

OH

KY

HI

AK

PA

WV VA

CTNJ

DE

MD

RI

NHVT

DC

MA

CO

NY

IA

MN

No public action