Why HIX delay matters more to some states than others
The Health and Human Services Department has extended the deadline for states to declare their plans for a state-based health insurance exchange for one more month to accommodate many governors who were waiting until the election outcome to decide whether to move ahead.
Calling the delay “insignificant for states building their own exchanges, but possibly significant for states still considering the best approach,” is Claudia Page, co-director of Social Interest Solutions, a non-profit technology and policy organization that helps connect low-income families to programs such as Medicaid and is working with states to implement health benefit exchanges.
“The extra time also gives the federal government a chance to get much needed guidance and clarifications out," Page explained, "which could influence some states' decisions."
The original deadline for states to submit their blueprint and a declaration letter to establish a state-based exchange was Nov. 16. The new deadline is Dec. 14, according to a letter dated Nov. 9 to governors from Health and Human Services Secretary Kathleen Sebelius, and reported by Kaiser Health News.
Originally, if states did not meet the Nov. 16 deadline, the federal government would then set up an exchange for them. HHS wants to be sure that the exchanges can be ready to start accepting open enrollment in October 2013 and start operations Jan. 1, 2014.
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According to the letter, HHS also will accept blueprints on a rolling basis from states that have decided to establish a state-federal partnership exchange. The final deadline to declare the partnership exchange will be Feb. 15, 2013. States will also be able to apply to run exchanges in subsequent years.
Many of the governors dragging their feet were Republicans, who were hedging their bets that if former Massachusetts Gov. Mitt Romney won the election that they would not have to create the online health insurance marketplaces. Romney had pledged to toss out the health reform law.
With President Barack Obama reelected, the Patient Protection and Affordable Care Act (ACA), now fully entrenched for implementation, will roll out with deliberate speed.
Sebelius said that HHS had heard from many states that additional time was needed to submit their blueprint application for an exchange.
“We are committed to providing you with the flexibility, resources, and technical assistance necessary to help you achieve successful implementation of your state’s exchange and look forward to continuing to work with you as we implement the healthcare law,” she said.
Exchanges will take one of three forms: state-based, state/federal partnership around claims management or consumer assistance or both, and federally facilitated. But HHS has said they believe that state-based exchanges are the best models for states.
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“Standing up a health benefit exchange is an enormous and complex undertaking," Social Interest Solutions' Page said. "Even for states that already have the ball rolling, meeting the aggressive deadlines is going to be an enormous challenge."
In the blueprint required by Dec. 14, for instance, states must provide details of their plans for a state-based or state/federal partnership exchange. Besides a letter of intent, the blueprint calls for an application to be filled out that will provide HHS with details of state plans.
States need to verify that they can perform certain required activities or the date when they anticipate being able to, such as involved with eligibility and enrollment; qualified health plan certification, management and oversight; consumer outreach and education, Internet website, support from consumer navigators; small business health options program or SHOP, technology infrastructure and compliance with HHS IT guidance; and privacy and security standards, policies and procedures.
Some of the activities will need supporting documentation, and states and their vendors will come up with testing and validation programs as part of a standard systems development process.
With all that is involved, however, the delay may not mean as much to states still resisting an HIX.
“We all know the dozen or so states planning to stand up an exchange,” Page said, “ but those are not the ones we're all curious about.”
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