Since January 1, 2014, consumers and small businesses in every state (including the District of Columbia) have had access to obtain health and/or dental insurance coverage through Individual or Small Business Health Options Program (SHOP) Health Insurance Exchanges, operated by States through State-based Exchanges (SBEs), or operated by the Federal government through the Federally-facilitated Exchange (FFE).
States who wish to establish a SBE are required to convey their intent in doing so by submitting a declaration letter to the Department of Health and Human Services (HHS), Center for Medicare and Medicaid Services (CMS). States were also eligible, through November 2014, to apply for Federal grants to support the establishment of their SBE. Since 2014, CMS’s Center for Consumer Information and Insurance Oversight (CCIIO) has been providing conditional approval for states requesting to establish a SBE. Historic declaration letters and other correspondence from States related to Exchange establishment can be found here. Since 2014, a few States who were conditionally approved to operate a SBE have transitioned to a different Exchange model. As of November 1, 2018, there are 12 SBEs, and 5 State-based Exchanges on the Federal platform (SBE-FPs). State-based Exchanges on the Federal Platform are SBEs who rely on HHS services for performing certain Exchange functions, particularly eligibility and enrollment, while still retaining responsibility for performing certain Exchange functions such as Qualified Health Plan (QHP) certification and consumer outreach and assistance functions. Two of the SBE-FPs also utilize the Federal platform for their SHOP eligibility functions. Three of the SBE-FPs operate a state-based SHOP program and are noted below by an asterisk next to the SBE-FP name.
Below is a list of the SBEs and SBE-FPs, and where available, a state’s declaration letter, HHS/CMS’ conditional approval letter, and a State’s Exchange website link. For further information, please contact the State directly.
Note: People using assistive technology may not be able to fully access information in these files. For assistance, please e-mail AltFormatRequest@cms.hhs.gov.
Updated: November 13, 2018