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Establishing the Exchanges

Under the Affordable Care Act (ACA), states were instructed to establish a state Insurance Exchange (Marketplace), or the federal government would do so for them.





States were given the option to develop their own state-administered Insurance Exchange, or to allow the Federal Government to establish a federally-facilitated Exchange (FFE). States could also partner with the federal government in establishing their Exchange through a federal-state partnership.


In any state that did not take action to establish an exchange, the federal government established one for the state by default.


State planning grants were offered to the states to make this determination.


All states had to declare their intent HHS by November, 2012 to either establish an Exchange that was state-run, join into a federal-state Partnership, or accept (or default to) a federally-facilitated exchange.


Those states wishing to establish their own State-run Exchange had to submit a blue print to HHS for approval by December 2012.






18 states declared that they would pursue establishing a state-run Exchange: California, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Kentucky, Maryland, Vermont, Massachusetts, Minnesota, Nevada, New Mexico, New York, Oregon, Rhode Island, Utah, Washington.



7 states determined that they would establish their Exchange through a state-federal partnership: Arkansas, Illinois, Michigan, West Virginia, Delaware, Iowa, New Hampshire.



26 states would ultimately have Federally-facilitated Exchange (FFE) established in their state: Alaska, Alabama, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Virginia, Wisconsin, Wyoming.



Learn More:


The specific routes by which state leaders, including the state legislatures and governors, made these determinations differed significantly from state to state.


The name and form of the final state exchanges, and also the plans participating in each state is also unique to each state.


To learn more about your state Exchange, and the background of the decisions that lead to its establishment, please visit the Health Reform in My State section.



Additional Information:


Establishing Health Insurance Exchanges: An Overview of State Efforts – Kaiser Family Foundation


State Insurance Exchanges – State Profiles – Kaiser Family Foundation


Health Insurance Marketplace Guide- Centers for Medicare and Medicaid Services