Qualified Health Plan Review in Marketplaces with State Plan Management: An Analysis of the Division of Labor Between State Exchanges and Other State Agencies
Gabbie Nirenburg, JD, MS, and Arthur Thourson Jones, PhD, Leonard Davis Institute of Health Economics
States have implemented a variety of different methods to handle the review and certification of qualified health plans (QHPs). The Health Insurance Exchanges (HIX) Research Group at the Leonard Davis Institute of Health Economics at Wharton (LDI) recently collected data from 30 states, including those with State Based Marketplaces (SBMs), State Partnership Marketplaces (SPMs), Supported State Based Marketplaces (SSBMs), and Federally Facilitated Marketplaces (FFMs) with state plan management. This brief summarizes the findings within this dataset, which outlines the various plan management and certification functions assumed by different state agencies across these marketplace models.
The full dataset and codebook is available here. The dataset also highlights the role CMS plays in SPM, SSBM, and FFM with state plan management states.
On January 15, 2025, the Centers for Medicare & Medicaid Services released updated State Health Official letter and Frequently Asked Questions guidance, replacing a previously issued SHO letter and FAQs on the requirement in the Consolidated Appropriations Act, 2023 that states provide 12 months of continuous eligibility for children and youth under the age of 19 in Medicaid and the Children’s Health Insurance Program, effective as of January 1, 2024.
