Feb. 19—Twenty-six states have chosen either to run their own health insurance marketplaces (formerly known as exchanges) or to partner with the federal government to run marketplaces in their jurisdiction as the Feb. 15 deadline for federal partnering passed. The remaining states opted out. Their populations will shop for insurance through the federal marketplace.

Seventeen states and the District of Columbia are on track to run their own marketplaces, beginning in October, according to the U.S. Department of Health and Human Services (HHS). Those states are California, Colorado, Connecticut, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, Oregon, Rhode Island, Utah, Vermont, and Washington. 

Seven states have sought approval to run a marketplace in partnership with the federal government. Three states—Arkansas, Delaware, and Illinois—have received conditional approval to run their marketplaces in partnership with the federal government, with four more pending approval: Iowa, Michigan, New Hampshire, and West Virginia.

At last tally, the 26 states that will let the federal government run their marketplaces are Alabama, Alaska, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Virginia, Wisconsin, and Wyoming.

View a current list of individual state’s marketplace efforts as well as a map of states that have received grant money for state-run marketplaces. 

HFMA Analysis: Regardless of what entity or entities are building and running a marketplace, providers will need to work closely with such entities to understand how a marketplace’s eligibility and enrollment systems work and then integrate those systems into their own revenue cycle workflows. Additionally, states that have defaulted to the federal option will need to keep an eye on the lawsuit filed by the Oklahoma state attorney general challenging the penalties large employers must pay if their employees receive subsidized coverage through the marketplace.

Publication Date: Tuesday, February 19, 2013