CREATING A NEW COMPETITIVE MARKETPLACE: HEALTH INSURANCE EXCHANGE ESTABLISHMENT GRANTS AWARDS LIST
In 2014, individuals and small businesses will have access to affordable coverage through a new competitive private health insurance market – State-based Affordable Insurance Exchanges. Today, HHS will award ten States a total of $229 million in grants, bringing the cumulative Exchange Establishment awards to date, to nearly $610 million to a total of 33 States and the District of Columbia. Additionally, one State has received a Level Two Exchange Establishment grant.
These grants are just the latest in an ongoing series of Affordable Care Act grants to help States develop Exchanges. Previously, 49 States and the District of Columbia received Exchange Planning grants and seven States received Early Innovator grants. While States are moving at different rates in the planning and establishment process, the vast majority of States have already taken the crucial early steps in building these new marketplaces. Numerous States have already expressed interest in applying to future rounds to build a robust Exchange for their residents.
Affordable Insurance Exchange Grants
Affordable Insurance Exchanges will provide individuals and small businesses with a “one-stop shop” to find and compare affordable, quality private health insurance options. With these Exchanges, Americans will no longer be on their own in trying to find comprehensive, affordable health coverage that is right for their needs. Exchanges will bring new transparency to the market so that consumers will be able to compare plans based on price and quality. By increasing competition between insurance companies and allowing individuals and small businesses to band together to purchase insurance, Exchanges will help lower costs.
On January 20, 2011, the U.S. Department of Health and Human Services (HHS) announced a new funding opportunity for Exchange Establishment grants to help states continue their work to implement this key provision of the Affordable Care Act.
The Exchange Establishment grants recognize that States are making progress toward establishing Exchanges but are doing so at different paces. States can choose when to apply for grant funding based on their needs and planned expenditures and states will have multiple opportunities to apply for funding in the years ahead, including opportunities to apply for multiple Level 1 grants as the planning process develops. As indicated in a November 29, 2011 Question and Answer document, CMS will continue to award Exchange Establishment grants through 2014. This process gives states maximum flexibility and ensures that states can move forward on their own timetables as they work to build an Exchange.
Each state’s insurance market is unique, and each state will require different levels of support as they create their Exchange. The final determination of each state’s grant award was made following a thorough examination of funding requested by the state, and an analysis of what would be a reasonable funding amount from the federal government.
There have been two previous series of grants to assist with the construction of state-based Exchanges:
· Forty-nine states and the District of Columbia received up to $1 million in Exchange Planning Grants. Four territories received similar grants on March 21, 2011. States receiving these funds have used them to conduct studies on the feasibility of Exchanges, and conduct community forums to hear directly from residents on how Exchanges should be established.
· Six states and a multi-state consortium led by the University of Massachusetts Medical School received over $241 million in Early Innovator grants to develop model Exchange IT systems. All Early Innovator states have committed to assuring that the technology they develop is reusable and transferable. Using the grants, they will develop the building blocks for Exchange IT systems, providing models for how Exchange IT systems can be created.
The states that will be awarded funding and the amounts they will receive are as follows:
Level Two Application Summary
Summary: Rhode Island will use Level Two funding to continue work already underway through its Level One grant, which includes: operations, IT infrastructure design and development; establishment of an integrated consumer support structure; reporting and evaluation; establishment of governance structures and staffing. Under the Level Two grant, Rhode Island will begin building its capacity in the following critical areas: health plan certification and qualification; financial sustainability; and oversight and financial integrity.
The state plans to implement these project areas as a single, integrated initiative, led jointly by Medicaid and Exchange leadership. The state will continue to work closely with the New England States Collaborative Insurance Exchange Systems collaborative and leverage IT systems knowledge and design where appropriate and feasible. Its total federal request is intended to fund the seven major projects listed above, plus implementation of technology components, which will be reviewed and refined through IT reviews conducted by CCIIO. Funding will be provided through December 31, 2014.
Level One Application Summaries
Summary: The Alabama Department of Insurance will use funding to support core staff, contracts, and activities around early implementation of the Alabama Health Insurance Exchange. Key activities of this cooperative agreement will include: coordination with the Alabama Health Insurance Exchange Study Commission to develop and implement an Exchange governance model; engaging stakeholders through the creation of a stakeholder group; early implementation of Exchange structures and functions, including financing, consumer functions like the website and call center, day-to-day Exchange operation, and integration with public health insurance programs. The Department of Insurance plans to work closely on this effort with the Governor’s Office of the Health Insurance Exchange, Medicaid, Children’s Health Insurance Program, Mental Health, and the Department of Finance’s Information Services.
Administrator: Arkansas Insurance Department
Award Amount: $7,665,483
Application Due Date: December 30, 2011
Level of Funding: Level One
Summary: Arkansas intends to build on its Exchange planning progress to design and implement key components of the Federally-facilitated Exchange Partnership Model in Arkansas. Using Establishment Grant funding, Arkansas proposes to design and implement automation to connect Arkansas Medicaid and appropriate State-run Exchange functions with the Federally-facilitated Exchange Eligibility and Enrollment portal; design, develop, and implement operations and information systems to support State-operated Federally-facilitated Exchange Consumer Assistance functions including outreach, education, and the Navigator Program; and design, develop, and automate State-operated Plan Management functions of the Federally-facilitated Exchange including Qualified Health Plan certification, rating, monitoring, and evaluation to effect continuous quality improvement. These activities will continue to be done in collaboration with state partners and informed by input from stakeholders. Arkansas also plans to design a temporary reinsurance program.
Summary: Arizona is focused on meeting the requirements for Exchange certification in 2013 and ensuring the Arizona Health Insurance Exchange is operational by January 1, 2014. With its Exchange Planning grant, Arizona has made progress in its Exchange planning with particular focus on background research, IT infrastructure and the certification of qualified health plans. Arizona will use Level One Establishment grant funding to secure the IT infrastructure necessary for a user-friendly website that is fully integrated with Arizona’s existing Medicaid web -based eligibility and enrollment system. Arizona will also finalize the plan management functions (including certification, recertification and decertification of health plans) to ensure that there are qualified plans available for individuals and small employers to select. Additionally, the Level One Establishment grant will enable Arizona to develop and implement plans for public education and outreach and determine how best to incorporate a Navigator program.
Summary: California will engage in planning, research and early implementation as appropriate in all 11 core areas identified in the federal Department of Health and Human Services application. This funding will help the state develop policy goals for the California Exchange as well as secure staff consultants and expert resources and actively engage stakeholders to inform and support Exchange planning and implementation activities. Level One resources will provide the information, data and consideration of options to support the state’s preparation and submission of a Level Two Exchange grant in spring 2012, leading to full implementation and operation of the Exchange by 2014.
Administrator: Colorado Health Benefit Exchange
Award Amount: $17,951,000
Application Due Date: December 30, 2011
Level of Funding: Level One
Summary: Colorado will use funding from its Level One Establishment Grant to continue to develop operational plans and activities that advance the progress of its Exchange. Using Establishment Grant funding, Colorado will build the Exchange operational staff and consulting support necessary to progress on key design requirements of the Exchange and some of the administrative and technical infrastructure to support it, including an operational plan through 2014 self-sustainability in 2015. Colorado’s principle deliverables under this grant include a fully developed plan for the administrative, technical, outreach and support systems necessary to the Exchange.
Summary: Connecticut will focus on three projects with this grant award. The first project is to determine the administrative issues involved in starting an Exchange, including the hiring of Exchange leadership and procurement of office space. The second project will build on the research provided by its Exchange Planning Grant and conduct a thorough analysis of information technology capabilities to focus on business process and information technology used in the Exchange. The third project is to develop appropriate capacity for consumer assistance and reporting requirements.
Summary: The Delaware Department of Health and Social Services (DHSS) will use Level One funding for the following key activities: developing a rules-based eligibility engine that will serve as the single, streamlined eligibility process for all medical assistance programs, including Medicaid, Delaware Healthy Children (the State’s Children Health Insurance Program) and the Exchange; preparing business and IT systems requirements for non-eligibility-related functions of the Exchange, and developing an operational plan; creating a financial management and sustainability model; enhancing Delaware’s consumer health assistance; engaging stakeholders; preparing statutory and regulatory changes for commercial health insurance, as required by the Affordable Care Act; assessing the impact to the commercial health insurance market from regulatory changes, the essential health benefits package, and the introduction of an Exchange as a purchasing platform in the individual and small group markets; and, reviewing existing programs to identify opportunities to leverage services, functions and resources that may be applicable to the Exchange, as well as opportunities to modify existing programs in light of the coverage expansions that will take effect in 2014.
With approximately 100,000 Delawareans currently uninsured– the expansion of Medicaid and the availability of subsidized commercial health insurance through the Exchange should provide many of those who are currently uninsured with access to affordable health coverage.
District of Columbia
Summary: Washington, DC will use its Level One Establishment Grant Funds continue and complete current planning and implementation efforts that would enable the District to establish a certified and functioning exchange by January 2014. The District estimates that approximately 225,000 of the District’s residents are expected to utilize District Exchange Services. The District’s Exchange project development staff has been working to establish a planning and requirements gathering framework for designing an Exchange that is representative of the unique health insurance needs of District residents and that reflects the preferences of stakeholders. This Level One funding will leverage the data, information and indicators gathered in the preliminary planning effort into a comprehensive project design document to be used to stand up the exchange in Level Two.
Summary: The Hawaii Department of Insurance will use Level One funding to establish the Hawaii Health Connector (“Connector”). The Connector is the Affordable Insurance Exchange for Hawaii enabled by Act 205 (SLH 2011). The Connector will serve individuals and small businesses throughout the State of Hawaii. The Connector will create a web portal that will make federally qualified health plans available to the public and reduce the number of uninsured in Hawaii.
Summary: Idaho will use Level One funds to complete necessary planning, research, design, development and implementation of its Exchange. The funding will assist the State in developing policy goals for the Idaho Health Insurance Exchange consistent with State and Federal law; securing staff, consultants and expert resources; actively engaging stakeholders to inform and support Exchange planning; and engage in related activities around Exchange design, development and implementation.
Summary: Illinois will use its resources provided by the Affordable Care Act to conduct additional Exchange research that will examine issues related to Risk-Adjustment/Reinsurance, Navigator Function, Certification of Qualified Health Plans, and SHOP Exchange. The state will build upon the Governor’s Health Reform Website where Stakeholders can offer their input. The state also plans on developing an Exchange Education Toolkit that it will make available both in print and online. To address Exchange IT Systems, the state will begin to design both the business requirements of the Exchange and IT detailed design for Illinois-specific aspects of the Exchange infrastructure. The state will also hire a fulltime employee for the Exchange who will manage the various fiscal responsibilities.
Summary: Indiana will use resources from the Affordable Care Act to strengthen the health information technology systems that will be integral to its Exchange. Additional funding will support project management, legal, actuarial, and financial expertise and general policy support.
Summary: The Iowa Department of Public Health will use Level One funding to conduct insurance market research and analysis to inform policy decisions on the design of its Affordable Insurance Exchange. The Department will conduct a financial assessment and budget analysis to determine the financial resources required to provide assistance to individuals and small businesses, coverage appeals, and complaints. The State will also develop a detailed Exchange business process, and associated business requirements for the Affordable Insurance Exchange IT system. Additionally, they will conduct focus groups and stakeholder outreach regarding user interface design and program development. Iowa intends to continue to plan and develop an integrated, automated eligibility system that meets the requirements of all programs, and plan for workforce training to reflect operations upon Exchange implementation.
Summary: Kentucky will use its grant to continue the state’s Exchange planning efforts. Much of the funding will be used for Information Technology systems (IT) to support the definition of business requirements, the procurement of an IT planning vendor, assistance with drafting an RFP for procurement of IT upgrades/and or new systems. The State would also focus heavily on outlining business operations for the Exchange.
Kentucky’s second Level One Establishment Grant will support an Operational Plan that details the planning, functional, and technical design of its Exchange. The State will create a business and sustainability plan, program integrity plan, a Medicaid Implementation Advanced Planning Document and will build an end-to-end eligibility and enrollment system to serve both Medicaid and Exchange participants. The technical work products include detailed technical and system requirements, reference architecture, application blueprint, integration and interface blue print, data management and subsystem blueprint and a security and risk assessment plan. Funding awarded through this grant will sustain Kentucky’s planning efforts for its Exchange.
Summary: Maine will use the Level One funding to: identify opportunities to leverage existing services, functions, and resources; continue stakeholder consultation; design and begin to build the business operations and systems for the Exchange, including the integration of existing Medicaid eligibility systems with new Exchange eligibility systems; develop consumer assistance capabilities; examine opportunities to modify existing programs in light of the coverage consolidations available to the state; secure expert resources to support the State’s Exchange planning and implementation process; and, engage in all other activities required to develop an Exchange that meets minimum federal requirements. Maine anticipates that the Level One funding will provide support to the State to collect and analyze data, consider options, and establish the framework for a potential submission of a Level Two Exchange grant in 2012.
Summary: Maryland will conduct policy development and detailed planning to build on the work of Maryland’s Exchange Planning Grant and Maryland’s Innovator Grant. The Level One Establishment Grant will result in data-driven and intensive policy analysis that will shape the technical and operational infrastructure of the Exchange. In addition, the activities performed with this funding will result in the rapid implementation of the Exchange IT platform, including product licensing, system integration, and independent verification and validation. The IT platform will be flexible to respond to forthcoming federal guidance and ongoing policymaking and input from Maryland stakeholders.
Administrator: Commonwealth of Massachusetts Health Insurance Connector Authority
Award Amount: $11,644,938
Application Due Date: December 30, 2011
Level of Funding: Level One
Summary: Massachusetts will use Level One funding to conduct analysis on coverage transitions and the operational interface between the Exchange and the Massachusetts Medicaid Program, which has been a major operational and strategic partner for the Health Connector since its inception. This will include a focus on the products and services that will best meet the needs of the individual and small group populations served in 2014. The proposed projects are intended to: enhance the consumer experience, (promote/provide) products and services for individuals and small businesses shopping for health insurance through an Exchange; help develop a plan for robust reinsurance, risk adjustment and risk corridor programs that will stabilize the market; and augment the current operational model for the relaunch of “Health Connector 2.0” in 2014.
Summary: The Michigan Department of Licensing and Regulatory Affairs (LARA) will use Level One funding to: conduct additional analysis on the impacts of the Exchange and the Affordable Care Act in Michigan, including additional insurance market analysis; acquire contractual services to assist the State and the Exchange with legal matters, technology planning, education and outreach, financing and policy issues; and, support the State of Michigan as it works toward establishment of this new entity.
Summary: Minnesota will use its resources under the Affordable Care Act to build on the Limited-Competition Exchange Planning grant it received in February 2011. Minnesota will focus on developing its Exchange information technology infrastructure. Minnesota also will establish an initial governance structure within the Minnesota Department of Commerce with full-time staff dedicated to the development of Minnesota’s Exchange. The state will also create and maintain an Advisory Task Force to provide guidance on the establishment of an Exchange. The state is requesting funding to develop and execute work plans, timelines, and budget and cost-allocation estimates through 2014. Minnesota will also designate a Chief Financial Officer to create and execute detailed work plans related to financial management, program integrity, and Exchange financing mechanisms.
Minnesota has received a second Level One Establishment Grant to support the design and development of its State Exchange. Minnesota has made substantial progress in the four months since receiving its first Level One Establishment Grant in August 2011. Minnesota will build on the work completed under the previous Planning and Level One grants, including designing and developing the Exchange IT system; consulting stakeholders and providing guidance from the Exchange Advisory Task Force; reviewing and analyzing business operations, program integration and financial management.
Summary: Mississippi will continue its planning for the establishment of a state-operated health benefit Exchange. Mississippi will: conduct an extensive public education and outreach program to inform consumers about access the health insurance through the exchange; continue to coordinate with Medicaid, CHIP and other appropriate programs regarding eligibility determination and other Exchange activities; and provide assistance to individuals and small businesses.
Summary: Missouri will build on its significant Exchange planning progress to implement a single, statewide exchange. Missouri will: build the exchange IT system, which will be highly coordinated with state agencies to enable a streamlined, single-portal eligibility and enrollment system; expand its existing stakeholder engagement process to facilitate deeper dialogue and leverage expertise on targeted topics; and, establish the appropriate levels of financial oversight and control to ensure program integrity.
Summary: The Nebraska Department of Insurance will use Level One funding to further its planning, research and design of an Exchange for the state. With its Exchange Planning grant, Nebraska has conducted a detailed market impact assessment, developed several financial and economic models studying Exchange sustainability, and has performed an IT system interface gap analysis between Medicaid and the Exchange. Using Level One funds, Nebraska will focus on several additional identified issues, including: further analysis of the effect of an Exchange on Nebraska’s insurance markets; creating a risk adjustment/reinsurance plan; performing additional studies on program integration and integrity; designing a comprehensive outreach and education plan; producing a thorough plan regarding Exchange design and financial management; further research regarding a SHOP exchange; and, writing an RFP for a comprehensive IT development plan.
Summary: Nevada will use funding to: develop a rules-based eligibility engine that will serve as the single, streamlined eligibility process for all medical assistance programs, including Medicaid, Nevada Check Up (the state’s CHIP program) and the Exchange; prepare business and IT systems requirements for non-eligibility-related functions of the Exchange, and develop an operational plan; create a financial management and sustainability model; enhance Nevada’s consumer assistance; engage stakeholders and consult with Nevada’s Native American Tribal community; prepare statutory and regulatory changes for commercial health insurance, as required by the Patient Protection and Affordable Care Act; assess the impact to the commercial health insurance market from regulatory changes, the “essential health benefits” requirements, and the introduction of an Exchange as a purchasing platform in the individual and small group markets; and, review existing programs to identify opportunities to leverage services, functions and resources that may be applicable to the Exchange, as well as opportunities to modify existing programs in light of the coverage expansions that will take effect in 2014.
Nevada will use its second Level One Establishment Grant for funding the development of a rules-based eligibility engine, business and IT systems requirements for non-eligibility-related functions of the Exchange, the development of an operational plan, and the review of existing programs to identify opportunities to leverage services, functions and resources that may be applicable to the Exchange, as well as opportunities to modify existing programs in light of the coverage expansions that will take effect in 2014.
Administrator: Department of Banking and Insurance
Award Amount: $7,674,130
Application Due Date: December 30, 2011
Level of Funding: Level One
Summary: New Jersey will use its Level One Grant to continue the planning efforts begun under its planning grant. New Jersey intends to close the identified IT gaps, gather stakeholder input on specific decision points, detail a financial management plan, establish audit and fraud detection procedures, develop reinsurance and risk adjustment plans, research Medicaid network issues, analyze projected plan costs and utilization, and further develop plans and standards for plan management, including options for defining Essential Health Benefits.
Summary: New Mexico will use Level One funding to develop and establish the New Mexico Health Insurance Exchange over the next 12 months and to meet the timelines for certification and operation by 2014. The objectives for Level One funding are to: refine the Exchange vision and objectives to comply with laws and regulations; amend state law as necessary to comply with federal law; secure staff and consultant resources for Exchange planning, development, implementation, operations, and stakeholder engagement; develop and implement a multi-year Exchange business and operational plan, including the activities, timelines, and benchmarks and the IT infrastructure and functionality necessary to fully operate in 2014; develop systems and program capacity in each core area to achieve Exchange certification by January 2013; submit a Level Two Establishment grant application in March 2012; begin Exchange operations in 2014; and, determine funding mechanisms to be self-sustaining by 2015.
Summary: New York has made significant progress under its exchange planning grant, early innovator grant, and consumer assistance program grant. This funding will: support background research; seek stakeholder input through a series of policy discussions focused on Exchange design and operation options; fund IT Systems; expand the capacity of its consumer assistance to serve the needs of small businesses, to expand assistance to individuals in regions of the State that currently have limited in-person access and expand consumer assistance with commercial insurance issues. The proposal also requests funding for key staff to begin the process of implementing the Exchange around governance.
With this second Level One grant New York will continue its preparations to demonstrate operational readiness as required under the proposed Exchange Certification process. New York will use funding to develop and deliver an operationally-ready New York Health Benefit Exchange IT system; integrate services, functions, processes and systems across state agencies with the Exchange; establish New York’s All Payer Database which will be an integral component of the Exchange’s quality rating process and risk adjustment methodology; provide the actuarial work for New York-specific risk adjustment methodology; and complete new analyses and refine existing studies. New York’s grant will also maintain key Exchange planning staff and help build the services for work in the areas of Exchange eligibility and enrollment; customer assistance, complaints and appeals; certification of quality health plans; and the SHOP Exchange.
Summary: North Carolina will engage stakeholders, prepare analyses of outstanding policy decisions, and expand the existing eligibility system of the North Carolina Department of Health & Human Services to accommodate the Exchange. The state will also: develop requirements for the non-eligibility related Exchange functions to prepare any necessary procurements; prepare North Carolina’s consumer assistance program in anticipation of 2014 requirements; develop a work plan, budget, and evaluation plan for the North Carolina Health Benefit Exchange (NCHBE); develop a post-2014 financial sustainability plan; and support initial operational activities of NCHBE.
Summary: The Health Insurance Exchange builds on Oregon’s past and current health reform efforts. Oregon has been studying an Exchange model for several years and is an Early Innovator IT grantee. This Establishment grant will support the state’s continued progress toward Exchange implementation. Funding will support the final design and initial implementation of the Exchange’s business and operations plan. To bring the business and operations plan to life, Oregon will use funding to: hire an Executive Director and key staff; build a financial management plan and structures; finalize waste , fraud, and abuse plans; appoint a Board of Directors to provide oversight and management; finalize interagency agreements with relevant agencies; develop transition plans for state programs and their enrollees; consult with stakeholders; determine whether additional risk mediation activities are required; finalize protocols and payment rules for producers and Navigators; develop marketing and communications strategies; begin evaluation activities; and create a detailed business plan in preparation for the February 2012 Legislative Session.
Administrator: Pennsylvania Insurance Department
Award Amount: $33,832,212
Application Due Date: December 30, 2011
Level of Funding: Level One
Summary: The Pennsylvania Insurance Department submitted an application for a Level One Establishment Grant to support continued progress toward the establishment of a State based Health Insurance Exchange. With funds from a Level One Establishment Grant, Pennsylvania plans to continue research-supported planning to assure that the state designs and facilitates the development of a new marketplace that meets the needs of its residents and the objectives of the State. The funds from this Level One Establishment Grant would allow Pennsylvania to complete planning for a Health Insurance Exchange and make decisions regarding development and design. The State would also begin the technical build of infrastructure modifications required for the Exchange’s technical systems, financial management, and business operations while preparing for consumer outreach and education.
Summary: Rhode Island will use resources from the Affordable Care Act to strengthen health information technology systems, develop an integrated consumer support program to provide support to individuals and small businesses, and strengthen its business operations
Summary: Tennessee will use Level One funding to continue planning and researching the core Exchange planning areas identified by HHS. This funding will primarily be used to procure technical expertise from consulting and information technology firms to develop business requirements for Exchange business architecture areas. The funding will also provide continued support for 2.5 full-time equivalent staff. Tennessee continues to work with State officials and stakeholders to determine and implement the best policy choices for Tennesseans. This application is the first of two potential applications for Level One funding – the second application is expected to be filed in December 2011.
In November 2011, Tennessee was awarded a $1.5 million Level One Establishment Grant which provided necessary funds to begin developing preliminary business requirements and RFPs for critical IT and operational functions necessary for successful Exchange implementation. Tennessee has also published a policy paper and continues to consult with stakeholders, other state officials and staff about the benefits and potential negative issues related to implementing and operating a state insurance exchange.
Tennessee submitted a second Level One Establishment grant for funding to support Exchange Planning staffing needs, ongoing review and analysis of new federal rules and guidance, planning for a health plan management system, marketing and outreach planning, consumer research assistance, and other administrative expenses. Tennessee continues to work with state officials and stakeholders to determine and implement the best policy choices for Tennesseans.
Summary: Vermont will use Level One funding to further its planning, development, and design of the Vermont Health Benefits Exchange (Exchange). Funding will support further development or continuance of a number of activities that Vermont initiated during its Planning Grant phase, including stakeholder engagement, program integration, financial management, health insurance market reforms, business operations, and the development of an information technology platform that collects and manages information in a streamlined process across various state and federal agencies. Vermont will also use funds to support a number of staff positions for the Exchange and its sister agencies to ensure that Exchange implementation activities and coordination work move forward as planned. Funding for implementing Vermont’s health insurance exchange platform is also included. Vermont intends to continue moving forward in the design of an Exchange that will provide interoperability with other government health care programs in the State, and a platform for the evolution of the single-payer health care system envisioned in Vermont statute.
Summary: Washington will use resources from the Affordable Care Act to develop options and recommendations on policy decisions that will have a significant impact on the Exchange. The grant will also provide funds to develop a health information technology system that will support its Exchange.
Summary: West Virginia will provide for several consumer quality and effectiveness related studies to ensure an efficient and value driven market transition into the Exchange, including further funding for actuarial services and economic modeling as envisioned under the Planning Exchange Grant. West Virginia will also use funding to: create tools for successful risk adjustment; undertake an Exchange issuer initiative and complete a producer and navigator strategic plan; allow for continued policy integration with constituent state agencies; and, develop a business and operational plan that will ensure financial sustainability by January 2015.