Health Insurance Exchanges

An important component of Health Care Reform is the availability of a health insurance exchange. An exchange is a transparent, centralized marketplace that will offer a choice of affordable, high-quality health insurance plans to individuals and small businesses. Plan enrollments are to begin October 1, 2013 with a coverage effective date of January 1, 2014.

Illinois Health Care Reform Implementation Council

The Illinois Healthcare Reform Implementation Council issued its report to Governor Quinn on March 1, 2011. The Council, comprised of directors of state agencies and departments responsible for implementing the Affordable Care Act (ACA), received input from consumers, providers, legislators and organizations throughout Illinois on how best to implement the ACA for the benefit of Illinois residents. Among the key recommendations is the establishment of a health insurance exchange for Illinois.

• Health Care Reform Implementation Council Initial Report
• Department of Insurance/Department of Healthcare and Family Services Presentation at 10/14/2011 HRIC Meeting

Illinois Health Benefits Exchange Law

On July 14, 2011, Governor Quinn signed Public Act 97-0142, the Illinois Health Benefits Exchange Law . This legislation, effective immediately, enables Illinois to establish its own health insurance exchange for individuals and businesses with 50 or fewer employees.

An Amendment to the Illinois Health Benefits Exchange Law was introduced during the Illinois General Assembly veto session on October 26, 2011. The Amendment to SB1313 includes provisions on specific aspects of the structure, function and financing of the Exchange.

The Amendment has been referred to the House Insurance Committee. The next meeting of the Committee is scheduled for November 8, 2011 at 2 pm.

Illinois Health Benefits Legislative Study Committee

The recently enacted Illinois Health Benefits Exchange Law (Public Act 97-0142) called for the creation of a 12-member Legislative Study Committee to issue a report to the General Assembly and the Governor on establishment of the Illinois Health Benefits Exchange. The final report of its findings was forwarded to Governor Quinn and the leadership of the General Assembly on October 18, 2011.

For a list of committee members, meeting notices and agendas for future meetings, as well as ongoing developments, visit the Illinois Health Insurance Exchange Legislative Study Committee.

Federal Regulations and Guidance

Five sets of federal regulations have been issued to guide states in implementation of the ACA.

• Initial Guidance to States on Exchanges

Proposed Rules

• Establishment of Exchanges and Qualified Health Plans
• Establishment of Exchanges and Qualified Corridors and Risk Adjustment
• Exchange Functions in the Individual Market: Eligibility Determinations; Exchange Standards for Employers
• Eligibility Changes under the Affordable Care Act of 2010
• Health Insurance Premium Tax Credit

Final Rules

• Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers Final Rule
• Standards Related to Reinsurance, Risk Corridors and Risk Adjustment Final Rule

Bulletins

• Value and Cost-Sharing Reductions (AV/CSR) Bulletin

Federal Exchange Planning and Establishment Grants

Illinois has been awarded the following grants by HHS to assist in planning and implementing the health insurance exchange in Illinois.

• Exchange Planning Grant
  • Illinois Application
  • Quarter 1 Grant Report to HHS
  • Quarter 2 Grant Report to HHS
  • Quarter 3 Grant Report to HHS
  • Quarter 4 Grant Report to HHS
• Cooperative Agreement to Support Establishment of State-Operated Health Insurance Exchanges
  • Illinois Level 1 Exchange Establishment Grant Application - Project Narrative
  • Illinois Level 1 Exchange Establishment Grant Application - Work plan and Timeline
    **NOTE: This work plan and timeline is an evolving document that will continue to be modified over time as the State's planning shifts with emerging needs.
  • Illinois Level 1 Exchange Establishment Grant Report Ending: 12/31/11
  • Illinois Level 1 Exchange Establishment Grant Report Ending: 06/30/12
• Level 1 Stage 2 application project Narrative

Reports Funded through Federal Grants

• Illinois Exchange Financing Options Report
• Illinois Risk Adjustment & Reinsurance Workplan
• Review of the Current Illinois Health Coverage Marketplace: Background Research Report
• Illinois Exchange Strategic and Operational Needs Assessment
  • Report
  • Appendices
• Eligibility System Assessment
• Illinois Navigator Report
• SHOP Exchange
• UIC Shop Report

Background Resources

• NAIC Exchanges Subgroup
  • NAIC Model Act – American Health Benefit Exchange
• Health Insurance Exchange -Stakeholder Conference (Video) (August 30, 2010)
• Health Insurance Exchanges and the Affordable Care Act: Eight Difficult Issues (T.S. Jost, The Commonwealth Fund, September 2010)
• Health Insurance Exchanges and the Affordable Care Act: Key Policy Issues (T.S. Jost, The Commonwealth Fund, July 2010
• Department Health Reform Webinars

Other State Exchange Legislation

• The Commonwealth Fund
• Kaiser Family Foundation
• State Refor(u)m