The state of Utah is set to break the mold and deliver dual health insurance marketplaces. After a decisive approval by the White House, Utah is set to establish two separate health insurance marketplaces that will cater to individuals and small businesses separately.
As per the current approval, two marketplaces will operate in Utah—one managed by the state and the other managed by federal government. As per the agreement established between the state of Utah and CMS, the small business health insurance marketplace will be run by the State of Utah under an adjusted set of the Affordable Care Act (ACA) rules. On the other hand, the federal government would cover the health insurance exchange for individuals and consumers.
The seeds of this unprecedented move were laid way back in 2008, when Utah proposed to form a separate small business health insurance marketplace, two years before the Patient Protection and Affordable Care Act (PPACA) was passed. A series of steps in 2008 and 2009 paved the way for the first Utah health insurance marketplace. In 2010 and 2011, amendments were made to the established health insurance marketplace, and it was reconfigured to comply with the requirements of PPACA. In an unprecedented move in May 2013, the White House allowed the coexistence of a state-led, small business health insurance marketplace and a Federally Facilitated Marketplace for individuals.
With the granting of approval on “Avenue H,” Utah’s small business SHOP health marketplace, the domain of operation for both the marketplaces has been clarified. The nod by CMS allows oversight to Utah over compliance, certification and decertification of all qualified health plans. The existing Medicaid structure would be utilized for administering the Medicaid program.
The approval and implementation of this unique collaboration between a state and CMS can be seen as a building block for more arrangements like this in the future. Although the ramifications of this joint effort are unclear as of now, industry watchers have a positive outlook and are expecting a stellar coordination-cum-performance by the two marketplaces.