In 2014, States With Federally-Facilitated Exchanges Can Not Run State-Based SHOP Exchanges

The Centers for Medicare and Medicaid Services (CMS) has released frequently-asked-questions (FAQs) on the small business health options program (SHOP) exchanges. The FAQs confirm that the CMS plans to propose regulations that would allow only states that have received conditional approval to operate a state-based individual exchange to also operate a state-based SHOP exchange in 2014.

Health insurance exchanges and SHOP exchanges were created under the Patient Protection and Affordable Care Act (ACA), and are scheduled to be operational beginning Jan. 1, 2014.

The only case in which a state with a federally-facilitated exchange would be allowed to run a state-based exchange would be if the state had received conditional approval to run a state-based individual exchange. In this case, the state must request to operate a state-based SHOP, and to have the individual exchange run by the Department of Health and Human Services (HHS). The CMS noted that all states would have the same option starting in 2015.

In 2015, states wishing to operate only a state-based SHOP exchange will be required to submit a blueprint to the HHS that is specifically being developed for the state-based SHOP/federally-facilitated individual exchange option. The CMS will release that blueprint at a later date.

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