This is the guidance from the Centers for Medicare & Medicaid Services Center for Consumer Information and Insurance Oversight for establishing federally-facilitated health insurance exchanges under the Patient Protection and Affordable Care Act.  States that choose to implement a federally-facilitated exchanges may still perform some functions, specifically health plan management and consumer assistance (including oversight of ACA-defined patient navigators to assist consumers in enrollment), in support of the federally-facilitated exchange.  Many states already have state departments of insurance that perform similar functions.  Of the 34 states that are implementing federally-facilitated exchanges, 15 states are performing either health plan management and/or consumer assistance functions.

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