Feds offer insurance marketplace partnership options for states

By Julian Pecquet - 09/19/11 01:44 PM ET

States will be able to get federal help in setting up their health insurance exchanges without having the government take over, under new rules proposed Monday.

The healthcare reform law requires states to have insurance exchanges up and running by 2014 if they don't want the federal government to run the show. New alternatives timed for this week's visit by state officials anxious for more clarity would create state-federal partnerships that offer a middle path, where both parties work together to operate different functions of the exchange.

The partnership model would allow states to tailor their exchange to local needs and market conditions, according to HHS, while offering states a way to transition to fully operating their own exchanges.

"Because each State has different needs, the Department of Health and Human Services (HHS) has worked to ensure that States have flexibility to implement the law to meet those needs," read an administration e-mail to congressional health staffers detailing the partnership options. "The goal of the Partnership is to take advantage of the State's expertise and knowledge of their insurance markets to support a seamless consumer experience."

The options unveiled Monday include:

• Having states tailor the health plan choices for their exchange by running plan management functions including the collection and analysis of plan information, plan monitoring and oversight and data collection and analysis. Under this option, HHS would coordinate with the state regarding plan oversight — such as consumer complaints and enrollment — and help to ensure that exchanges meet all of the required standards;

• Having states assist consumers' access to exchange plans by overseeing in-person consumer assistance, managing the Navigator program that will help provide direct assistance to help people sign up for insurance and conducting outreach and education. HHS would run more centralized consumer assistance functions such as call center operations, the consumer website and written correspondence with consumers; or

• Having states run both the plan management and consumer assistance functions.

States and other stakeholders have until Sept. 28 to comment on the proposal.