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Exchange Operational Models for 2021

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Summary

In 2021, most states are relying on the federal government for some or all exchange operational functions.

Fourteen states and DC are operating state-based exchanges (SBEs), including New Jersey and Pennsylvania , which transitioned to SBEs in 2021. In the other 36 states, the federal government will perform some or all activities, including eligibility determinations, enrollment, website operation, and consumer outreach. Of these 36 states, 10 are contributing to exchange management under a partnership or marketplace plan management model. Five states are in the process of transitioning from the federally facilitated exchange platform to an SBE.

Figure 1. States’ Exchange Operational Models Have Remained Stable Since 2016
Figure 1. States’ Exchange Operational Models Have Remained Stable Since 2016

FFE: Federally-Facilitated Exchange; SBE: State-Based Exchange; SBE-FP: State-Based Exchange Using Federal Platform

Source: Avalere State Policy 360.

  1. The governor of Virginia signed a law transitioning the state from a FFE model to an SBE model in 2023.
  2. Maine’s governor submitted a letter of intent to CMS indicating the state is working to transition from an FFS to an SBE-FP model beginning in 2022.​
  3. The board of New Mexico’s health insurance exchange unanimously voted to transition from an SBE-FP model to an SBE model by fall 2021; Kentucky’s governor indicated the state would transition back to an SBE by Fall 2021.
  4. Georgia is seeking to transition from a FFE model to a SBE model through a Section 1332 waiver application.

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