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State Implementation

The Affordable Care Act (ACA) included several key provision that were left to the states to implement, including the establishment of the new State Insurance Exchanges, and the Medicaid Expansion


As a result, the implementation of the ACA has occurred very differently in each state. To learn more about what is happening in your state, please visit the Health Reform in My State section.






Following the law's passage, the Department of Health and Human Services (HHS) issued a multitude of rules and regulations pertaining to implementation of various provisions of the law. 


Many of the provisions of the law were left to the states to determine and implement, giving each state broad power to determine how the requirements and provisions of the ACA would be fulfilled and organized.



State Insurance Exchanges:



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



Learn More: Background On Establishing The Exchanges




Qualified Health Plans & Pricing:



The insurers offering Qualified Health Plans for individuals to purchase in the State Insurance Exchanges differ from state to state as do Plan Premiums and Pricing levels.



Medicaid Expansion:



Under the  ACA law, the Medicaid program in every state was scheduled to be expanded to 138% of federal poverty level. However, a Supreme Court Decision struck down the mandatory portion of the requirement, leaving Medicaid Expansion as an option available to states.



Ryan White


The federal Ryan White Program was implemented differently in each state prior to the ACA. However, since the program is a payer-of-last-resort program, the populations served, wrap-around services offered, and premium assistance offered through the program differs in each state.



Learn About Your State:



To learn more about what is happening in your state, please visit the Health Reform in My State section.