Maryland HIX advances with operations proposals

By Mary Mosquera
12:38 PM

The organization developing Maryland’s health insurance exchange delivered recommendations to the governor and state legislature to support its operations, bringing the state another step closer to one-stop shopping for health coverage in 2014.

The Board of the Maryland Health Benefit Exchange recommended policies for how the exchange will contract with insurance plans; offer insurance to small businesses and their employees and how a navigator program should work.

[Q&A: The A, B and C of U.S. States' HIX IT needs.]

The board also endorsed how to set rules to assure a broad pool of risk; finance the exchange; and educate and inform the public about new opportunities for health insurance, said Dr. Joshua Sharfstein, Secretary of the Maryland Department of Health and Mental Hygiene and chair of the Exchange Board.

Maryland’s Health Benefit Exchange will provide a marketplace for individuals and small businesses to purchase quality and affordable health coverage. The Affordable Care Act will offer subsidies in some instances to make health insurance more accessible.

State exchanges must be certified for operation by Jan. 1, 2013 and go live Jan. 1, 2014. The Maryland legislature authorized creation of a health insurance exchange in April. 

“One at a time, we are putting in place the building blocks for a successful exchange in Maryland,” Sharfstein said in a Dec. 27 announcement, adding that these policy recommendations “focus on what it will take for the exchange to work well in Maryland.”

[See also: 13 U.S. states garner HHS funds for HIX.]

To craft the recommendations, the board worked with representatives from the health insurance industry, healthcare providers and associations; community-based organizations; academia; business owners; unions; local government officials; and community members.

Among its recommendations, the exchange board urged that the exchange:
• Establish additional criteria for qualified health plans above the requirements of the health reform law and modify its approach to contracting over time;
• Require that carriers above a minimum participation threshold offer products in the exchange;
• Assure that carriers offering a catastrophic plan, such as for young, healthy individuals, outside the exchange participate to support exchange viability;
• Develop separate navigator programs for individual and small group markets to assist them in finding insurance and integrate it with Medicaid’s outreach and enrollment;
• Make transition-of-care wording in contracts part of qualified health plan certification and work with Medicaid to reciprocate care transition provisions in managed care organization contracts.