Interested in making the switch to a state-based marketplace? Explore the resources below to help you start planning your move. Have questions? We’re here to help – just send us an email at hello@getinsured.com.
SBM Build-Out Timeline
There are critical activities that must be completed when moving to a state-based marketplace. Understanding these key steps can help you plan and anticipate any challenges. A quick look at some of these activities on a sample timeline is below.
State-Based Marketplaces
Curious about what state-based marketplace platforms are like? There are plenty of examples to explore.
- California: Covered California
- Colorado: Connect for Health Colorado
- Connecticut: Access Health CT
- District of Columbia: DC Health Link
- Georgia: Georgia Access
- Idaho: Your Health Idaho
- Illinois: Get Covered Illinois
- Maryland: Maryland Health Connection
- Massachusetts: Massachusetts Health Connector
- Minnesota: MNsure
- Nevada: Nevada Health Link
- New Jersey: Get Covered NJ
- New Mexico: BeWell NM
- New York: NY State of Health
- Pennsylvania: Pennie
- Rhode Island: Health Source RI
- Vermont: Vermont Health Connect
- Virginia: Virginia’s Insurance Marketplace
- Washington: Washington Healthplanfinder
Want to check out the state exchanges anonymously? Try one of the scenarios below:
Female, 54
Takes one prescription medication:
- Prozac (brand name or generic)
Male, 55
Takes three prescription medications:
- Lipitor (brand name or generic)
- Prilosec (brand name or generic)
- Xiidra (only brand name available)
Recent State Legislative Actions
One of the first steps in establishing a state-based marketplace is passing state legislation authorizing and governing the SBM. Here are a few examples:
- Georgia State-Based Marketplace Bill SB 65
- Illinois State-Based Marketplace House Bill 579
- Maine Health Coverage Act and Improve Health Choices
- New Jersey State-Based Marketplace Bill
- New Mexico State-Based Marketplace Bill HB 100
- Oregon State-Based Marketplace Bill SB 972
- Pennsylvania State-Based Marketplace Bill HB 3
- Virginia Health Benefit Marketplace Bill HB 1428
Governor Letters Requesting an SBM
Governors are required to send a letter to CMS noting their intention to transition to a state-based marketplace. These are publicly available letters that can be used as a model for future state letters.
2023
2020
- Kentucky (6/16/20)
- New Mexico (6/4/20)
- Virginia (5/6/20)
2019
- New Jersey (3/22/19)
- Pennsylvania (7/1/19)
2018
2012
- California (7/10/12)
- Colorado (10/8/12)
- Connecticut (7/10/12)
- District of Columbia (11/15/12)
- Idaho (12/14/12)
- Maryland (10/9/12)
- Massachusetts (7/10/12)
- Minnesota (11/15/12)
- New York (11/15/12)
- Oregon (7/6/12)
- Rhode Island (7/5/12)
- Vermont (7/9/12)
- Washington (7/10/12)
State-Based Marketplace Blueprint
A “blueprint” is a document that tells CMS how your state intends to build out and operate its exchange.
State-Based Marketplace and Reinsurance Program Cash Flow
User fees collected from on-marketplace health insurers can be allocated to support both the operation of a state-based marketplace and a 1332 waiver reinsurance program, leveraging additional federal reinsurance funds to maximize market stability. The following diagram offers an example of how this cash flow has worked for Pennsylvania; actual figures will vary by state and year.
The Affordable Care Act (ACA) & 1332 Waiver Guidance
Here you’ll find the actual text from the Patient Protection and Affordable Care Act (PPACA), which is often shortened to the Affordable Care Act (ACA). You can also find the latest guidance on how to utilize 1332 waivers.
- Affordable Care Act (certified full-text version)
- Reconciliation Act (certified full-text version)
- Section 1332 State Relief and Empowerment Waiver Concepts (November 2018)
- Data Brief on Section 1332 Waivers (April 2024)
- 1332 Waiver Applications and Approvals
Marketplace Integrity and Affordability (MIA) Rule and H.R. 1 (One Big Beautiful Bill Act) Guidance
Full text for these important changes as well as guidance on how to navigate them can be found here:
State-Based Marketplace Requests for Information (RFI)
Thinking of putting out an RFI? Here are a few examples from other states:
- Arkansas: Best Practices and Requirements for a State-based Marketplace
- Maine: State-based Marketplace Transition
- Michigan: Health Insurance Exchange Platform and Customer Service Center Request for Information
- Minnesota: Consumer Shopping, System of Record, Enrollment Decision Support, and Small Business Health Options Program Tools for MNsure (PDF)
- Nevada: Integrated Online Health Insurance Exchange Platform and Associated Consumer Assistance Center
State-Based Marketplace Requests for Proposals (RFP)
Thinking of putting out an RFP? Here are some examples from other states:
- Illinois: Illinois SBM IT Platform and Call Center Services
- Maine: Health Insurance Marketplace Technology Platform and Consumer Assistance Services
- Minnesota: Consumer and Small Business Shopping, System of Record, and Enrollment Decision Support Tools for MNsure RFP (PDF)
- Nevada: Health Insurance Exchange Technology Platform and Customer Service Center
- New Jersey: The Development of a Technology Platform and Consumer Assistance Center for New Jersey’s State Based Health Exchange
- New Mexico: RFP for Individual Marketplace Solution and Contact Center Services
- Oregon: State-Based Marketplace Solution Vendor Request for Proposals
- Pennsylvania: Technology Platform and Consumer Assistance Center for the Pennsylvania Health Insurance Exchange
- Virginia: Health Benefit Exchange Solution
Market Studies, Webinars & Additional Resources
How do state-based marketplaces affect local health insurance markets? Below are some resources to help you consider how an SBM may impact your state:
- ACA Marketplace Open Enrollment Numbers Reveal the Impact of State-Level Policy and Operational Choices on Performance – The Commonwealth Fund
- COVID-19 Impact on Medicaid, Marketplace, and the Uninsured, by State – HMA
- Health Insurance Markets Perform Better in States That Run Their Own Marketplaces – The Commonwealth Fund
- Many States with COVID-19 Special Enrollment Periods See Increase in Younger Enrollees – The Commonwealth Fund
- State-based Exchange Directors Share their Marketplace Successes with Congress – NASHP
- Wide Variations in State Health Insurance Costs – 4SightHealth
State-Specific Outcomes
- Nevada’s Insurance Exchange Director Talks about Transitioning to a State-Based Marketplace and Saving Millions – NASHP
- State-Based Marketplace Policy Brief for New Hampshire – New Hampshire Insurance Department/Freedman HealthCare
- The Your Health Idaho Marketplace: A Model for State-Based Adoption – Leavitt Partners
Transition Considerations and Resources
- Adopting a State-Based Health Insurance Marketplace Poses Risks and Challenges – CBPP
- List of State-Based Health Insurance Resources – NASHP
- “So You Want to Build a State-based Marketplace? Here’s How!” — Advice from Marketplace Leaders – NASHP
- “So You Want to Build a State-Based Marketplace? Here’s How!” – Webinar Deck – NASHP
- States Seek Greater Control, Cost-Savings by Converting to State-based Marketplaces – Robert Wood Johnson Foundation
GetInsured: A Trusted Partner
GetInsured is an experienced state-based marketplace technology and service provider, with an expert team ready to help you each step of the way in your state’s transition to a state-based marketplace. Reach out to ask questions and talk details here.
Get in touch
Want to learn how an SBM can specifically help your state, as well as estimate your savings? Email GetInsured’s Business Development at hello@getinsured.com.