Territory Establishment Grants

Each territory listed here received one Affordable Insurance Exchange grant award. Summaries of their applications for this grant are provided below:


American Samoa


Administrator: American Samoa Government
Amount Awarded: $1,000,000
Award Date: March 21, 2011

  • Develop an Exchange that will pace new investment and private industry by facilitating the purchase of qualified health plans and development of a Small Business Health Options Program.
  • Design the platform and database structure for health insurance policy program development and ensure it is well-maintained and updated.
  • Create the needed infrastructure for health plan development.
  • Invite, review and secure health insurance plans that meet local needs.
  • Develop a process for health plan development, review and monitoring.
  • Build a secure, comprehensive data structure to support future data collection activities.



Administrator: Guam Department of Revenue and Taxation
Amount Awarded: $1,000,000
Award Date: March 21, 2011

  • Conduct a survey of small businesses to gather the data on insured and uninsured employees including those that might be eligible for the Exchange, and those that are eligible but not enrolled in Medicaid or employer's coverage.
  • Conduct stakeholder outreach to gather input on the construction of an Exchange.
  • Evaluate and test the Exchange functions and train staff in all phases of the Exchange functions.
  • Formulate and submit a legislation creating a Governance structure.

Puerto Rico


Administrator: Puerto Rico Department of Health
Amount Awarded: $917,205
Award Date: March 21, 2011

  • Conduct background research about Puerto Rico's uninsured and underinsured populations and current insurance market to understand the populations to be served by the Exchange.
  • Model the potential impact of the Exchange.
  • Conduct necessary stakeholder outreach.
  • Research, analyze, and make recommendations related to the Exchange's administrative structure, operations, and integration with existing government agencies and programs.
  • Review Puerto Rico's current capabilities to manage processes such as eligibility and applications, payment of premiums, development of benefit packages, and oversight.

U.S. Virgin Islands


Administrator: Government of the Virgin Islands
Amount Awarded: $1,000,000
Award Date: March 21, 2011

  • Examine the feasibility of an Exchange, conduct initial Exchange planning, and work toward the establishment of an Exchange.
    Research the Territory's private insurance market, with the goal of increasing participation in the Exchange by individuals and small employers.
  • Conduct stakeholder interviews and focus groups with individuals and employers, with an emphasis on accessing hard-to-reach uninsured individuals.
  • Develop a program model for the prospective Exchange and associated subsidies, including an analysis of how best to ensure continuity of coverage.
  • Explore Exchange governance models, especially the feasibility of a regional Exchange involving one or more States and/or Territories.
  • Determine the statutory and administrative actions within the Territory that are needed to establish the Exchange.
  • Conduct a gap analysis to identify needed improvements in information systems in order to implement the Exchange.
  • Develop a detailed work plan for Exchange planning and implementation activities, as well as an ongoing analysis of Exchange-related staffing and resources needs.
  • Create a report on the detailed findings concerning the actions needed to implement an Exchange under the Affordable Care Act.

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