The Centers for Medicare & Medicaid Services (CMS) has issued guidance on the establishment of state partnership exchanges to implement the health insurance and Medicaid expansions under the Patient Protection and Affordable Care Act.  As of the December 14, 2012 deadline, only 20 states had declared their intent to operate a state-run health insurance exchange.  The remaining 30 states and the District of Columbia have until February 15, 2013 to declare their intent to operate a state partnership exchange, in which they would share operational responsibility with the federally operated exchange.

The guidance details how the state would share that operational responsibility with the federal exchange, specifically on managing health plans that would be offering health insurance through the exchanges, and on integrated consumer assistance programs.  States may seek federal funding to support the establishment of a partnership exchange.

The guidance clarifies that if a state decides to implement a state partnership exchange for 2014, it still may transition to a state-based exchange in later years.  States seeking such a transition for 2015 would have to notify CMS of its intent to operate a state-based exchange by November 18, 2013.

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