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The Maryland Health Benefit Exchange

Background

The Affordable Care Act (ACA) requires states to either establish and operate a Health Insurance Exchange by 2014 or participate in the federal Exchange. Maryland’s Health Benefit Exchange (Exchange) will allow Marylanders to compare rates, benefits, and quality among plans to help individuals and small employers find an insurance product that best suits their needs.

The Exchange will also be the entity that calculates and provides tax credits to eligible small employers and advanceable tax credits for individuals below 400 percent of the federal poverty level. Private insurers will compete in this open marketplace, creating an even playing field and providing transparent and accurate information so that Marylanders can make important decisions about their health care options.

Enabling Legislation

Because of the state’s strong desire to show leadership and self-determination, Maryland chose to operate its own Exchange, rather than join a multi-state Exchange or default to a federal Exchange. On April 12, 2011 Governor O’Malley signed into law the Maryland Health Benefit Exchange Act of 2011. This legislation lays the foundation for the development of Maryland’s Exchange in three parts.

  • Framework and Governance Structure: The bill creates the Exchange as an independent public entity. Specific provisions promote transparency, accountability, flexibility and coordination with a range of partners.

  • ACA Provisions: The bill establishes those functions and duties that are required as part of the ACA. Other provisions, which are subject to state discretion, will be added at a later time.

  • Study and Recommendations: The bill directs the Exchange to conduct a study and make recommendations in several important policy areas, and it directs the Exchange to submit the report and recommendations to the legislature prior to proceeding with decisions in these areas. In general, the study will address how best to operate the Exchange within Maryland’s unique health care and health insurance delivery systems.

Next Steps

The Exchange Board held its first meeting on June 3. Over the next year, the Exchange will hire initial staff, establish advisory committees, and analyze key strategic decisions for Maryland’s Exchange, including whether to create a separate exchange for the small group market; whether to engage in selective contracting; and how to design the navigator program. The Exchange will also evaluate how to build upon existing resources in the state, including insurance producers, third-party administrators, health care advocates, and other relevant entities, to execute the required functions of the Exchange. The Exchange will make recommendations on these issues and others by early 2012.

Final Reports