Seven States’ Actions to Establish Exchanges under the Patient Protection and Affordable Care Act

The ACA and the Department of Health and Human Services (HHS) regulations require states and American Health Benefit Exchanges (exchanges) to carry out a number of key functions, for which state responsibilities vary by exchange type. A state that chooses to operate its exchange is responsible for: (1) establishing an operating and governance structure, (2) ensuring exchanges are capable of certifying qualified health plans and making them available to qualified individuals, (3) developing electronic, streamlined, and coordinated eligibility and enrollment systems, (4) conducting consumer outreach and assistance, and (5) ensuring the financial sustainability of the exchange. A state that partners with HHS may assist HHS with certain functions, such as making qualified health plan recommendations and conducting aspects of consumer outreach and assistance. Despite some challenges, the seven selected states in GAO’s review reported they have taken actions to create exchanges, which they expect will be ready for enrollment by the deadline of October 1, 2013