State Health Insurance Exchange Decision


Each state has three options for the type of exchange they want to setup. They can elect to build an exchange that is managed and implemented by the state, They can choose a partnership where the state exchange is partnered with the Federal Exchange, or default and let the Federal government facilitate their exchange, if a State defaults, the Secretary of HHS will establish and maintain the exchange of any state that decide not to establish a state-based exchange. Consequently in the partnership model States will have a greater role, they may administer plan functions, in-person consumer assistance, or both, and The federal government will perform the remaining exchange functions.

State Health Insurance Exchange Options


State-Based Exchange:  State will establish state-based exchanges

Partnership Exchange: State will partner with the federal government to operate an exchange

Federal Exchange: State will default to a federally-facilitated exchange

Undecided: State have not yet communicated a decision

State Health Insurance Exchange Structure

Existing Agency: Establish as part of an already existing state agency

Independent Agency:  public agency

Non-Profit: Will setup as a Non-for profit agency

State Based, and Partnership exchanges will have the flexibility for decision for setting up their plans . This requires a contract only with one health plan that will meet minimum federal requirements for qualified health plans.


State Health Insurance Exchange
Decision Status

United States

Exchange Status

Federal Approval Status

Structure of Exchange

Type of Exchange

AlabamaDefault to Federal ExchangeNANANA
AlaskaDefault to Federal ExchangeNANANA
ArizonaDefault to Federal ExchangeNANANA
ArkansasPlanning for Partnership ExchangeConditional approvalNANA
CaliforniaDeclared State-based ExchangeConditional approvalQuasi-governmentalActive purchaser
ColoradoDeclared State-based ExchangeConditional approvalQuasi-governmentalClearinghouse
ConnecticutDeclared State-based ExchangeConditional approvalQuasi-governmentalClearinghouse
DelawarePlanning for Partnership ExchangeConditional approvalNANA
District of ColumbiaDeclared State-based ExchangeConditional approvalQuasi-governmentalClearinghouse
FloridaDefault to Federal ExchangeNANANA
GeorgiaDefault to Federal ExchangeNANANA
HawaiiDeclared State-based ExchangeConditional approvalNon-profitClearinghouse
IdahoDeclared State-based ExchangeConditional approvalQuasi-governmentalClearinghouse
IllinoisPlanning for Partnership ExchangeConditional approvalNANA
IndianaDefault to Federal ExchangeNANANA
IowaPlanning for Partnership ExchangeConditional approvalNANA
KansasDefault to Federal ExchangeNANANA
KentuckyDeclared State-based ExchangeConditional approvalOperated by StateNot yet addressed
LouisianaDefault to Federal ExchangeNANANA
MaineDefault to Federal ExchangeNANANA
MarylandDeclared State-based ExchangeConditional approvalQuasi-governmentalClearinghouse
MassachusettsDeclared State-based ExchangeConditional approvalQuasi-governmentalActive purchaser
MichiganPlanning for Partnership ExchangeConditional approvalNANA
MinnesotaDeclared State-based ExchangeConditional approvalQuasi-governmentalClearinghouse
MississippiDefault to Federal ExchangeState-based blueprint rejectedNANA
MissouriDefault to Federal ExchangeNANANA
MontanaDefault to Federal ExchangeNANANA
NebraskaDefault to Federal ExchangeNANANA
NevadaDeclared State-based ExchangeConditional approvalQuasi-governmentalClearinghouse
New HampshirePlanning for Partnership ExchangeConditional approvalNANA
New JerseyDefault to Federal ExchangeNANANA
New MexicoDeclared State-based ExchangeConditional approvalQuasi-governmentalNot yet addressed
New YorkDeclared State-based ExchangeConditional approvalOperated by StateActive purchaser
North CarolinaDefault to Federal ExchangeNANANA
North DakotaDefault to Federal ExchangeNANANA
OhioDefault to Federal Exchange2NANANA
OklahomaDefault to Federal ExchangeNANANA
OregonDeclared State-based ExchangeConditional approvalQuasi-governmentalActive purchaser
PennsylvaniaDefault to Federal ExchangeNANANA
Rhode IslandDeclared State-based ExchangeConditional approvalOperated by StateActive purchaser
South CarolinaDefault to Federal ExchangeNANANA
South DakotaDefault to Federal ExchangeNANANA
TennesseeDefault to Federal ExchangeNANANA
TexasDefault to Federal ExchangeNANANA
UtahDefault to Federal ExchangeNANANA
VermontDeclared State-based ExchangeConditional approvalOperated by StateActive purchaser
VirginiaDefault to Federal ExchangeNANANA
WashingtonDeclared State-based ExchangeConditional approvalQuasi-governmentalClearinghouse
West VirginiaPlanning for Partnership ExchangeConditional approvalNANA
WisconsinDefault to Federal ExchangeNANANA
WyomingDefault to Federal ExchangeNANANA
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