1. Know the Ropes: Exchange Development Issues for Kids and Families Charting the Way: Progress and Priorities for Child and Family Coverage July 18, 2012

2. 2 Source: Genevieve M. Kenney, et al., Improving Coverage For Children Under Health Reform Will Require Maintaining Current Eligibility Standards For Medicaid And CHIP, Health Affairs, December 2011.

3. FL NC SC GA LATX AL AR KS OKAZ TN MS NV UT NM CA WY ID WA OR ND SD NE MT MO IN MI WI IL ME OH KY HI AK WV VA CT NJ DE MD RI NH VT DC MA CO IA NY MN PA Where Do States Stand? States committed to state- based exchange States committed to partnership exchange

4. FL NC SC GA LATX AL AR KS OKAZ TN MS NV UT NM CA WY ID WA OR ND SD NE MT MO IN MI WI IL ME OH KY HI AK WV VA CT NJ DE MD RI NH VT DC MA CO IA NY MN PA Exchange Establishment Grants States that have received exchange establishment grants

5. The Timeline Ahead DateMilestone Oct. 1, 2012States choose EHB benchmark plan Nov. 16, 2012State submits Exchange Blueprint Jan. 1, 2013 HHS (conditionally) certifies exchanges Oct. 1, 2013Exchanges begin enrollment Jan. 1, 2014QHP coverage begins 5

6. Exchange Blueprints 6 State Based Must detail all exchange activities Can use federal services for: Subsidy determination IRR exemption Risk/reinsurance Partnership Must detail Plan Management and/or Consumer Assistance activities Can use federal services for: Medicaid/CHIP eligibility Reinsurance FFE No Application required, Declaration Letter requested Can use federal services for: Medicaid/CHIP eligibility Reinsurance

7. Responders o Sabrina Corlette o Georgetown University Center on Health Insurance Reforms o Anna Strong o Arkansas Advocates for Children and Families o Christina Peters o Children’s Alliance 7

8. Guest Speaker 8 o Yvette Fontenot, Deputy Director o HHS Office of Health Reform

10. *Maine, Massachusetts, New Jersey, New York, and Vermont required insurers to provide coverage to individuals on a guaranteed basis prior to the Affordable Care Act and, thus, already prohibited the denial of coverage to children under age 19. **Kentucky issued a regulatory order which is binding on all insurers marketing individual health insurance. ***Nevada issued a temporary regulation which expired. The state currently has no special rules regarding child-only coverage. ****Texas passed a new law allowing the Department of Insurance to adopt rules to “increase the availability of coverage to children younger than 19 years of age” but no new regulations have yet been issued. Source: Authors’ analysis. Exhibit 1. State Action to Promote the Availability of Child-Only Coverage, as of January 2012 Issued new regulation regarding child-only market Issued sub-regulatory guidance regarding child-only market Passed new law regarding child-only market FL NC SC GA LATX**** AL AR KS OK AZ TN MS NV*** UT NM CA WY ID WA OR ND SD NE IN MT MO MI WI IL ME* OH KY** HI AK PA WV VA CT NJ* DE MD RI NH VT* DC MA* CO NY* IA MN Took no official action regarding child-only market

11. * The Arkansas Plan Management Advisory Committee has selected the three largest small group plans for benchmarking and referred the final decision regarding which plan to the Insurance Commissioner. Exhibit 2. Essential Health Benefits Benchmark: State Action, as of May 31, 2012 Conducting analysis (internal or public) Made a selection Conducting analysis and seeking public input FL NC SC GA LA TX AL AR* KS OK AZ TN MS NV UT NM CA WY ID WA OR ND SD NE IN MT MO MI WI IL ME OH KY HI AK PA WV VA CT NJ DE MD RI NH VT DC MA CO NY IA MN No public action