On Dec. 20, Kathleen Sebelius, Secretary of Health and Human Services, announced that the Department of Health and Human Services (HHS) had issued conditional approvals to three states as they move to implement health insurance exchanges. On Thursday, HHS issued conditional approvals to Minnesota and Rhode Island to operate state-based health insurance exchanges under the terms of the Affordable Care Act (ACA), while Delaware received the first conditional approval to establish a state partnership exchange. Under the terms of the ACA, state governments are required to choose one of three options with regard to health insurance exchanges, which will allow uninsured Americans to shop for and obtain health insurance plans online: states can run their own insurance exchanges; they can partner with the federal government to create “state partnership exchanges”; or, if state leaders decline to establish any exchange on their own, the federal government will establish and run federal exchanges in those states.

Thursday’s announcement follows conditional approvals that HHS has issued last week to Colorado, Connecticut, the District of Columbia, Kentucky, Massachusetts, Maryland, New York, Oregon, and Washington to operate state-based exchanges. “The conditional approval provided to Delaware today is the first of its kind and shows the vast progress Delaware has made ahead of the Feb. 15, 2013, deadline to apply to operate a State Partnership Exchange,” Secretary Sebelius said in a press release.

Now, all but eight states have declared their intentions, according to the National Academy for State Health Policy. According to a recent article in the specialized newsletter Health Business Daily, the eight states whose leaders have still not declared their insurance exchange intentions are Idaho, Montana, North Dakota, Utah, New Mexico, Tennessee, Pennsylvania, and new Jersey. Meanwhile, 17 states and the District of Columbia have established or declared their intention to establish a state-based exchange; five are considering or have declared their intention to establish a partnership-model exchange; and 20 states have defaulted, meaning that the federal government will establish exchanges in their states (see map).

By law, every state and the District of Columbia must be prepared for the start of open enrollment in the state-level health insurance exchanges by Oct. 1, 2013, and all 51 exchanges must be prepared to open for business in January 2014.

The information technology and data challenges involved in all this are legion, Jordan Battani told Healthcare Informatics recently. Among the many areas of challenge are defining interface standards, working through eligibility verification issues, and, for provider organizations that are themselves employers, working from that standpoint to assist their employees with insurance issues.