State Marketplace Profiles: Delaware
Updated as of October 10, 2013
Establishing the Marketplace
In July 2012, Governor Jack Markell (D) indicated that Delaware would begin planning for a State Partnership Marketplace.1 Delaware will retain plan management and consumer assistance functions, and defer other Marketplace management functionality to the federal government.2 In July 2013, the state announced that the Marketplace would be called Choose Health Delaware.
The Delaware Health Care Commission, housed within the Department of Health and Social Services (DHSS), led the process of planning for a Marketplace in Delaware. The Commission, originally created in 1990 with the goal of improving the provision of health care for residents of Delaware, includes ten members representing the executive and legislative branches of government and public and private sectors.3 The Commission also works with the Governance and Policy Subcommittee of the Health Care Reform Steering Committee, which was created in 2010 within the Department of Health and Social Services to implement health reform within the state.
Contracting with Plans: In April 2013, the Delaware Department of Insurance (DOI) issued a Qualified Health Plan (QHP) submission guide for issuers.4 Issuers may offer plans in the individual Marketplace, the Small Business Health Options Program (SHOP) Marketplace, or both. All issuers must offer at least one plan on each of the gold, silver, and bronze tiers, and all QHPs must be available in all three counties in the state; there will be no plans with partial service areas. Rates may vary by age, family composition, and tobacco use (by up to 1.5:1), but not geography. Issuers must also comply with Delaware’s continuity of care requirements in order to become certified. Issuers are required to establish a plan for consumers moving between QHPs and Medicaid, including a transition period of at least 60 days for prescription medications.
Issuers submitted plans to DOI beginning in May. The DOI reviewed plans for compliance with state and federal regulations and submitted recommendations to the Centers for Medicare and Medicaid Services (CMS) for certification on July 30. CMS conducted an additional review and performed final QHP certification in mid-September.5 Three issuers offer a total of 21 QHPs for individuals through Choose Health Delaware, including two multi-state plans. Two issuers provide 11 offerings through the SHOP marketplace. Information on plan rates is available on the Choose Health Delaware website.
Delaware has a number of state-specific network adequacy requirements that supplement federal guidelines. For example, issuers must ensure that a primary care provider is located within 20 miles and no further than 30 minutes driving time from a member’s place of residence. Providers must also meet the state’s Medicaid standards for timely access to care.
In addition to compliance with federal quality requirements, Delaware requires issuers to participate in state quality improvement workgroups and to submit data to the Delaware Health Information Network. Issuers who offer stand-alone dental plans only are not required to comply with these quality standards.
Risk Adjustment, Reinsurance, and Risk Corridors: Delaware anticipates that the federal government will administer the state’s reinsurance program.6
Consumer Assistance and Outreach: In July 2013, Choose Health Delaware awarded a total of over $5 million to four Marketplace Assister organizations that will hire and manage up to 68 Guides to educate consumers statewide about the Marketplace and facilitate enrollment in QHPs.7 In August 2013, HHS awarded $500,000 in Navigator grant funding to a single entity in Delaware to hire five to seven individual Navigators. Navigators in Delaware have the same training and certification requirements as Marketplace Guides and will perform the same services; the difference between the two types of assisters will be indiscernible to the consumer. Choose Health Delaware will coordinate and oversee all Guide and Navigator activities. Additionally, three Federally Qualified Health Centers (FQHCs) in Delaware received a total of $339,000 from HHS to perform outreach and enrollment assistance functions.
Choose Health Delaware’s outreach and marketing campaign is intended to target consumers (young adults, middle aged adults, the uninsured, and the underserved), small businesses, and those who influence consumers, such as social workers, community leaders, and nurses. In early September, the DOI and DHSS hosted a Marketplace kickoff event, during which they announced the launch of a marketing campaign and introduced the four Marketplace Guide organizations.8 The marketing campaign includes television, print, radio, billboard, shopping mall, and mass transit advertising. Advertisements are tailored towards specific populations, with different strategic messages for 18-29 year olds and 30-64 year olds. Choose Health Delaware bar coasters and cash jackets are also being distributed to raise awareness of the Marketplace.
The campaign includes grassroots outreach at locations like libraries, community centers, and churches and at community events, such as the Delaware State Fair. Staff and volunteers distribute informational cards and brochures to educate consumers on the Marketplace, as well as pens, grocery bags, hand sanitizer, and band aids branded with Choose Health Delaware’s logo to raise awareness.8 The Marketplace is also conducting a series of educational webinars targeting the small business community.5
Licensed agents/brokers that complete the training and registration process will be eligible to sell coverage through Choose Health Delaware. Agents/brokers will continue to be compensated by issuers; issuers are required to pay agents/brokers the same commission, regardless of whether the plan is sold on or off of the Marketplace.9 Navigators and Marketplace Guides will undergo training on handoffs to agents/brokers. The Marketplace website also includes a list of agents/brokers and contact information for each.
In July 2013, the DOI and DHSS, in partnership with the federal government, launched a consumer-facing website, including information in Spanish and a subsidy calculator. Choose Health Delaware’s consumer contact center is operated by the federal government and provides services in 150 languages.
Small Business Health Options Program (SHOP) Marketplace: Small employers with up to 50 employees are eligible to purchase coverage through the SHOP Marketplace in 2014 and 2015; the SHOP must offer coverage to employers with up to 100 employees in 2016.10 As required by federal guidance, individual and SHOP risk pools will be separate in Partnership Marketplaces. In 2014 small employers will select a plan and benefit level for employees; however, beginning in 2015 it is expected that employers will be able to choose a set of SHOP plans from which employees will be able to select the most appropriate coverage.11
Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Marketplace, cover certain defined health benefits. Delaware selected the Blue Cross Blue Shield Small Group EPO as the benchmark plan.12 Delaware will supplement the benchmark plan with the Federal Employee’s Dental and Vision Insurance Program for pediatric dental and vision services.13 In addition, Delaware adopted the standard requiring habilitative services to be offered at parity with rehabilitative services.
The Delaware Department of Health and Social Services received a federal Exchange Planning grant of $1 million in 2010. In November 2011, Delaware was awarded a Level One Establishment grant for $3.4 million to ready business and information technology systems for an exchange. Delaware received a second Level One Establishment grant for $8.5 million in January 2013 to support the review of qualified health plan (QHP) applications, to implement a consumer assistance program, and to fund an outreach and education campaign.14
On December 20, 2012, Delaware received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a Partnership Marketplace.15 The Choose Health Delaware Marketplace portal became operational on October 1; consumers may download a paper application from the website but cannot apply for Marketplace or Medicaid coverage directly through Delaware’s site. The federal government is operating the online eligibility and enrollment system and consumers must use the federal portal to apply for coverage online.
“How Each State Will Approach Health Care Act.” USA Today. July 13, 2012.
“Delaware QHP Certification Standards: Final Draft for HCC Approval”. (Accessed November 14, 2012)
State of Delaware, “Who Serves on the Delaware Health Care Commission?” (Accessed July 31, 2012)
Issuer QHP Submission Guide. Delaware Department of Insurance. April 23, 2013.
Delaware Health Benefit Exchange Project Update. Delaware Health Care Commission Meeting: March 28, 2013.
Letter from Governor Jack Markell to Secretary Sebelius. November 14, 2012.
Delaware Health Insurance Marketplace Project Update. Delaware Health Care Commission Meeting: August 7, 2013.
Delaware Health Insurance Marketplace Project Update. Delaware Health Care Commission Meeting: September 5, 2013.
Delaware Health Insurance Exchange Planning Frequently Asked Questions: Agents and Brokers.
Delaware Health Benefit Exchange Marketplace Assister Certification. Delaware Health Care Commission Meeting: February 7, 2013.
Delaware Health Care Commission. “Essential Health Benefits- Supplemental Plan Packet.” Accessed November 14, 2012.
“Delaware Health Benefit Exchange (HBE) Project Update.” Presented to the Delaware Health Care Commission on December 6, 2012.
Letter from Secretary Sebelius to Governor Markell. December 20, 2012.
also of interest
- After King v. Burwell Ruling, Health Law Issues Involve Implementation
- Analysis of 2016 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces
- Facing the Fallout From a King v. Burwell Ruling
- How Will the Uninsured in Delaware Fare Under the Affordable Care Act?