Delaware health insurance exchange

The federal government approved Delaware’s plan for a partnership exchange in December 2012. The Delaware Health Care Commission (DHCC), which is part of Health and Social Services department, is overseeing the state’s role in the health insurance exchange – or health insurance marketplace. Delaware has received about $13 million in federal grant money to plan and implement its portions of the exchange.

While some states are adopting a partnership exchange as an incremental step toward an eventual state-run exchange, Delaware is unlikely to go that route according Rita Landgraf, cabinet secretary of the state Health and Social Services department. Delaware may, however, consider a regional partnership in the future, whereby the state would partner with one or more other states. A regional partnership would spread administrative cost over a wider population and increase the size of the risk pool.

Under the partnership model, Delaware will have regulatory oversight of health plans operating on the exchange and will handle consumer outreach functions. The federal government will be responsible for determining who is eligible to purchase insurance and who qualifies for subsidies, enrolling eligible consumers, and operating the exchange website and call center.

In November 2012, the DHCC approved standards for certifying qualified health plans (QHPs). QHPs will be required to offer at least one bronze-level plan, have adequate provider networks, develop transition plans for consumers who move to Medicaid, and have documented quality improvement strategies.

In the first part of 2013, DHCC is developing the role of market assisters. Market assisters are unique to the state-federal partnership model. Market assisters will play a role similar to that of navigators, but be selected and managed exclusively by the state. In early January, DHCC approved requirements for market assisters: they must participate in training, must not be employed by an insurer, and must disclose any compensation received from an insurer in the past two years.

Delaware has also selected its benchmark plan for essential health benefits: the Blue Cross Blue Shield Small Group EPO. The Blue Cross plan will be supplemented with the Federal Employee’s Dental And Vision Insurance Program for pediatric dental and vision services.

With its small population, Delaware anticipates 35,000 people will be insured through its exchange.

Updated Feb. 1, 2013