Plan Management

This paper funded by the Robert Wood Johnson Foundation, and authored by a joint team from Georgetown University’s Health Policy institute and the National Academy of Social Insurance, provides insight for state and federal officials considering how they will assume responsibility for managing health plans once health insurance exchanges are established. Under the Affordable Care Act, one of the core functions that state health insurance exchanges must engage in is plan management—including activities like certifying qualified health plans, collecting and reviewing rate and benefit information, managing contracts, monitoring ongoing compliance issues, and running an open enrollment process, among others.

In order to better understand the capacity for plan management in the states, as well as some of the challenges they face moving forward, the authors review states’ current regulation of plans in their commercial marketplaces and Medicaid programs. The researchers closely examined six states—Arizona, Minnesota, New York, Tennessee, Washington and Wisconsin—in order to inform their analysis. The report finds that states will have to expand their regulatory activities once they establish a health insurance exchange in order to assume responsibility for managing health plans.