Utah’s Solution for State-based Health Exchange Moves Forward

Utah’s Solution for State-based Health Exchange Moves Forward
Utah and Dept. of Health and Human Services agree upon bifurcated model

SALT LAKE CITY – Today Utah Governor Gary R. Herbert announced an agreement has been reached between the State of Utah and the U.S. Department of Health and Human Services (HHS) on how Utah will run its health exchange.  The new model bifurcates the Small Business Health Options Program (SHOP) component from the individual exchange. Utah will now run its own health exchange, Avenue H, as the certified SHOP exchange in the state, servicing small businesses without a competing federal solution or interjection from the federal government.

“The only way this was going to work was if we were granted flexibility. Fortunately for all, HHS proved to be flexible, concurring with everything we proposed to be able to operate an exchange that meets the needs of Utah residents,” said the Governor.  “The new model clearly outlines what Utah will do and what HHS will do. We are sticking with our exchange and moving forward.”

Last February, the Governor met in Washington, D.C., with HHS Secretary Kathleen Sebelius and proposed an alternative to the three existing exchange options, a whole new model for a state to operate its health exchange. Since the meeting, Utah and HHS have been in negotiations.

“All along we’ve been clear that Utah’s health exchange is working and we plan to run it as is,” said the Governor. “After receiving a conditional approval, we knew that in order for us to move forward ‘as is’ with full approval, we needed to propose a new model for HHS to consider. So we did.”

Under Utah’s model, the State will maintain oversight over qualified health plans, including certification, recertification, decertification and compliance. The State will also continue to administer its Medicaid program through its existing Medicaid structure.

HHS will be responsible for operating the individual exchange mandated by the Affordable Care Act, conducting precertification for Medicaid and CHIP eligibility, and managing tax credits through the individual exchange.

In a letter sent to Sebelius yesterday, the Governor reiterated his position opposing the State of Utah sharing collected data with the federal agencies. After receiving the response letter from HHS, the Governor stated, “HHS acknowledges our limitations and agreed to my proposal. Our SHOP will be required to report only aggregated data that contains no information that identifies an individual or employer.”

The Governor later added, “These compromises are critical and must remain over the years in order to make health reform work for Utah residents.”

For more details on Utah’s marketplace approach, see the attached document or visit www.utah.gov/governor.