Not sure where to start in transitioning to a State-Based Marketplace? Below are some resources to help you start planning. Have questions? We’re here to help, just send us an email at hello@getinsured.com.
Model RFP for State-Based Marketplace
The RFP process ensures that the development and implementation of the SBM are done efficiently, transparently, and in the best interest of the state and its residents.
A model RFP (Request for Proposal) serves as a template or a guide for states when preparing for a real RFP. It helps streamline the process and ensures that all essential elements are included, ultimately resulting in a more efficient and effective procurement process.
Both a standard model RFP and a model RFP for states that would also like to implement Enhanced Direct Enrollment (EDE) are available.
SBM Build-Out Timeline
There are critical activities that must be completed when looking to build a State-Based Marketplace. Below is a quick look at some of these.
State-Based Marketplaces
- Nevada | Board Meetings
- New Jersey | Board Meetings
- New York | Board Meetings
- Pennsylvania | Board Meetings
- Rhode Island | Board Meetings
- Vermont | Board Meetings
- Washington | Board Meetings
Shopping on State-Based Marketplaces
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
- 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
News, Interviews & Additional Resources
- On June 5, 2020, executive directors from 14 state-based insurance marketplaces (SBM) sent a letter to Congressional leaders voicing support for federal efforts to reinforce insurance markets during the COVID-19 pandemic. You can read the letter here.
- State-based Exchange Directors Share their Marketplace Successes with Congress
- NASHP: Nevada’s Insurance Exchange Director Talks about Transitioning to a State-Based Marketplace and Saving Millions
- CBPP Report: Adopting a State-Based Health Insurance Marketplace Poses Risks and Challenges
- NASHP: List of State-Based Health Insurance Resources
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 the publicly available letters that can be used as a model for future state letters.
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)
- Rhode Island (7/5/12)
- Vermont (7/9/12)
- Washington 7/10/12)
State-Based Marketplace Blueprint
A “Blueprint” is a document in which your state tells CMS a little about how you intend to build out and operate your exchange.
State-Based Exchange Cash Flow Illustration
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)
- 1332 Waiver Applications and Approvals
State-Based Marketplace Requests for Information (RFI)
Thinking of putting out an RFI? Here are what other states have done.
- Arkansas: Best Practices and Requirements for a State-based Marketplace
- Maine: State-based Marketplace Transition (Word Doc)
- Michigan: Health Insurance Exchange Platform and Customer Service Center Request for Information
- MNsure (Minnesota): Consumer Shopping, System of Record, Enrollment Decision Support, and Small Business Health Options Program Tools for MNsure (PDF)
- Silver State Health Insurance Exchange (Nevada): Integrated Online Health Insurance Exchange Platform and Associated Consumer Assistance Center
- beWellnm (New Mexico): Health Insurance Exchange Platform
- Oregon Health Insurance Marketplace: State-Based Marketplace Technology Platform and Consumer Assistance Center
State-Based Marketplace Requests for Proposals (RFP)
Thinking of putting out an RFP? Here are what other states have done.
- Maine: Health Insurance Marketplace Technology Platform and Consumer Assistance Services
- MNsure (Minnesota): Consumer and Small Business Shopping, System of Record, and Enrollment Decision Support Tools for MNsure RFP (PDF)
- Silver State Health Insurance Exchange (Nevada): Health Insurance Exchange Technology Platform and Customer Service Center
- beWellnm (New Mexico): Individual Marketplace & Customer Engagement Center RFP
- Pennsylvania Health Insurance Exchange Authority (Pennsylvania): Technology Platform and Consumer Assistance Center for the Pennsylvania Health Insurance Exchange
- Get Covered New Jersey (New Jersey) The Development of a Technology Platform and Consumer Assistance Center for New Jersey’s State Based Health Exchange
- Virginia: Health Benefit Exchange Solution
Market Studies & Webinars
How do state-based exchanges affect local health insurance markets? Below are some resources to help you consider how an SBM may impact your state.
- State-Based Marketplace Policy Brief for New Hampshire – New Hampshire Insurance Department/Freedman HealthCare
- Many States with COVID-19 Special Enrollment Periods See Increase in Younger Enrollees – The Commonwealth Fund
- Study: States Seek Greater Control, Cost-Savings by Converting to State-based Marketplaces – Robert Wood Johnson Foundation
- The Your Health Idaho Marketplace: A Model for State-Based Adoption – Leavitt Partners
- ACA Marketplace Open Enrollment Numbers Reveal the Impact of State-Level Policy and Operational Choices on Performance – The Commonwealth Fund
- Study: Wide Variations in State Health Insurance Costs – 4SightHealth
- Study: Health Insurance Markets Perform Better in States That Run Their Own Marketplaces – The Commonwealth Fund
- Study: COVID-19 Impact on Medicaid, Marketplace, and the Uninsured, by State – HMA
- Webinar: “So You Want to Build a State-based Marketplace? Here’s How!” — Advice from Marketplace Leaders – NASHP
- Webinar Deck: “So You Want to Build a State-Based Marketplace? Here’s How!” – NASHP
State-Based Marketplace Vendors & Key Organizations
There are experienced vendors who can help you each step of the way in your transition to a state-based marketplace.
Organizations assisting with the operation and formation of SBMs:
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.