The January 1, 2014 federal deadline for states to have health insurance exchanges up and running is fast approaching, and as summer comes to a close, states are realizing just how fast time is flying.

Surprisingly, several states have yet to pass legislation to set up the infrastructure, and in some cases, have returned federal funding. However, this has not stopped states like Kansas from moving forward. The state gave back $31.5 million in federal funding from the Early Innovator Grant after Governor Sam Brownback's administration deemed it to have "too many strings attached." Nonetheless, the state still plans to continue in the same direction with the development of an optimal solution for the insurance exchange. Kansas plans to use 90/10 funding and will be applying for a Level 1 Establishment Grant. The state recently released a draft timeline for the exchange and anticipates a solicitation release midway through FY 2012 if a competitive process is decided upon. Some of the main goals in creating an exchange include providing a system with best possible outcomes for Kansas consumers, balancing administrative effectiveness, ensuring continuity of care, and providing user-friendly access to the exchanges.

Oklahoma also gave back federal funding. The state returned $54 million from the Early Innovator Grant after refusing to comply with the health care bill's mandates. A joint committee has been created to recommend how the state should address the federal health care law. The first meeting will take place today, September 14, in the House chamber at the Oklahoma State Capitol; it is expected to feature key members of the Health Insurance Exchange Steering Committee from the Oklahoma Health Care Authority. Early this year, the state introduced Legislation SB971, which would have established the "Oklahoma Health Insurance Private Enterprise Network," but the bill failed to make the legislative session.

Alaska, one of two states that refused to apply for planning grant funding, is now taking steps toward setting up architecture for a future exchange. Alaska Health and Social Services Commissioner William Streur confirmed that the department plans to issue a request for proposals (RFP) in the coming weeks for consultants to assist in designing Alaska's future exchange. Governor Sean Parnell considered the federal health care overhaul unconstitutional; however, the state plans to proceed with the development of an insurance exchange with its own money.

Here is a look at some other state statuses:

• California: The state recently released a competitive negotiation process for business and operations planning process services under the Level 1 Establishment Grant. The selected contractor will assist staff in developing a comprehensive business and operations plan.
• Missouri: The Missouri Health Insurance Pool (MHIP) released a request for information (RFI) for health insurance exchange component solutions and services; responses are currently under review. The state received $20.9 million earlier this year under the Level 1 Establishment Grant and plans to build an exchange IT system that will be highly coordinated with state agencies to enable a streamlined, single-portal eligibility and enrollment system.
• Nevada: The Nevada Health and Human Services Department was recently awarded $4.05 million in Level 1 Establishment Grant funding for its exchange. The state plans to use funding to develop a rules-based eligibility engine that will serve as a single, streamlined eligibility process for all medical assistance programs including Medicaid, Nevada Check Up and the exchange.
• Washington: The Washington Health Care Authority released a selective solicitation for project manager and deputy project managers for the health insurance exchange project. Selected vendors must be prequalified under ITPS. The state also plans to release a solicitation for call center services in September 2012.
• Wyoming: The Wyoming Health Benefits Exchange Steering Committee has been meeting to discuss options for the state's insurance exchange. The committee is expected to submit a draft of its proposals by October 1, 2011. The group is looking at elements such as financial feasibility to create the exchange, regional partnerships, and whether to seek an extension to 2015 from the federal government.

Though numerous states are ostensibly sluggish when it comes to establishing legislation for health insurance exchanges, they still must move forward with planning efforts. For that, states will continue to create workgroups and steering committees to review various options and make recommendations for future exchanges. States that have yet to set up legislation should not be dismissed, as there may be opportunities for vendors to take part in planning and development. Moreover, vendors should not overlook states returning federal funding, since they will use money from other sources to cover costs for exchange implementation. Furthermore, as always, states are looking for cost-effective solutions that do not sacrifice quality in the delivery of services to their customers. As a result, vendors should continue to work toward user-friendly, modular technology for these systems.

Deltek's Health Care and Social Services team will continue its blog series to celebrate National Health IT (HIT) Week. Make sure to check out tomorrow's blog on Electronic Health Records and Friday's on health IT budgets across the states.

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