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State Exchange Profiles: North Dakota

North Dakota

Updated as of December 11, 2012

Establishing the Exchange

In November 2012, Governor Jack Dalrymple (R) announced that North Dakota was not planning a state exchange.1 In the previous year, North Dakota had explored the possibility of a state-based exchange, spurred in part by enacted legislation stating North Dakota’s intent to create a health insurance exchange.2 The Insurance Department collected stakeholder feedback and identified a vendor to analyze the state’s demographics, insurance market, and policy options.3,4However, planning efforts halted after a second 2011 bill to establish an exchange failed.5

The legislative Health Care Reform Review Committee continues to receive regular updates from the Insurance Commissioner and Department of Human Services regarding the state’s planning and implementation of the Affordable Care Act.6 The Committee’s July meeting included a discussion of a state-federal partnership exchange and the possibility of the state taking over a federally-run exchange at a later date.7

Information Technology (IT): Although the state is not currently moving forward with building an exchange, it is focusing on improvements to North Dakota’s Medicaid eligibility system with the goal of ensuring a seamless connection with an exchange.8 The legislature passed HB 1475 which provides for an IT update of the Medicaid eligibility system within the Department of Human Services.9 This legislation, considered necessary for either a state- or federally-run exchange in North Dakota, was signed into law by Governor Dalyrmple on November 11, 2011.

In addition, the Health Benefit Exchange Interagency Planning Committee was formed by the Insurance Department in 2011 and includes the Department of Human Services, Information Technology Department, the Department of Human Services, the Governor’s Office, and the Office of Management and Budget.10 In 2012, the Committee shifted its focus away from exchange planning and towards upgrading the Medicaid eligibility IT system.

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 Exchange, cover certain defined health benefits. The Health Care Reform Review Committee discussed EHB benchmark options after receiving a subcontractor analysis and public comments. On October 1, 2012, the North Dakota Insurance Department submitted Sanford Health Plan, an HMO plan, as the EHB benchmark.11 The state also submitted the Children’s Health Insurance Program (CHIP) as supplemental benefits for pediatric dental and vision services.

Exchange Funding

In September 2010, the North Dakota Insurance Department received a federal Exchange Planning grant of $1 million. The Department was denied the appropriation to use the funds until the legislature appropriated the funds during 2011 legislative session. The appropriation became available on July 1, 2011.

As of January 25, 2012, over three-quarters of the Planning Grant funds remained unspent.12 The Insurance Department proposed transferring the remaining funds to the Department of Human Services to allow for additional planning and development of the tools necessary to create a one-stop eligibility system for Medicaid and the exchange.

Next Steps

The federal government will assume full responsibility for running a health insurance exchange in North Dakota beginning in 2014.


1. Wetzel D. “ND GOP Leader Rethinking Options on Health Care Law, Says State Administration Possible.” The Republic. November 15, 2012.http://www.therepublic.com/view/story/a769f030589848afad9db0d40ae69867/ND–Health-Care-North-Dakota
2. HB 1126, North Dakota’s 2011 act announcing the state’s intent to create a Health Benefit Exchange. http://www.legis.nd.gov/assembly/62-2011/documents/11-8110-05000.pdf
3. Odney Advertising. “North Dakota Health Benefit Exchange Stakeholder Final Report.” September 23, 2011. http://www.nd.gov/ndins/uploads%5Cresources%5C689%5Cfinal-stakeholder-meeting-report.pdf
4. Health Technology Management Services (HTMS). “Health Benefit Exchange Planning Services: Narrative Summary.” December 2, 2011. http://www.nd.gov/ndins/uploads/resources/700/final-hbe-planning-narrative.pdf
5. HB 1474. North Dakota’s 2011 act to establish a Health Benefit Exchange.http://www.legis.nd.gov/assembly/62-2011/special-session/documents/11-0806-08000.pdf
6. North Dakota Health Care Reform Review Committee. http://legis.nd.gov/assembly/62-2011/docs/committeestructure/hc.pdf (Accessed September 5, 2012).
7. Minutes of the Health Care Reform Review Committee meeting on July 25, 2012.http://legis.nd.gov/assembly/62-2011/interim-info/minutes/hc072512minutes.pdf
8. North Dakota’s “State Planning and Establishment Grant for the Affordable Care Act’s Exchange: Final Project Report.” January 25, 2012.
9. HB 1475. North Dakota’s 2011 Act to Provide Appropriations for Certain Medical Services, Health Insurance, Economic Assistance, and Information Technology and Programs.http://www.legis.nd.gov/assembly/62-2011/special-session/documents/11-0836-02000.pdf
10. North Dakota’s “State Planning and Establishment Grant for the Affordable Care Act’s Exchange: Final Project Report.” January 25, 2012.http://www.nd.gov/ndins/uploads/resources/702/final-report.pdf
11. North Dakota EHB Communication (Accessed November 16, 2012).http://www.statereforum.org/sites/default/files/ehb_communication.pdf
12. North Dakota’s “State Planning and Establishment Grant for the Affordable Care Act’s Exchange: Final Project Report.” January 25, 2012.