State Exchange Profiles: Ohio
Updated as of March 25, 2013
Establishing the Exchange
On November 16, 2012, Governor John Kasich (R) notified federal officials that Ohio would default to a federally-facilitated exchange; however, the state would maintain regulatory control over its insurance industry.1 The Governor also indicated Ohio would maintain control over Medicaid eligibility determinations.
Prior to the announcement, the Department of Insurance in collaboration with other stakeholder agencies solicited subcontractors’ assistance for the first year of exchange planning and implementation. Contractors evaluated financing options and sustainability, provided actuarial services and economic modeling, and an information technology (IT) gap analysis.2,3,4
On December 21, 2011, the Governor signed HB 79, which prohibits qualified health plans purchased through an exchange from covering abortions, except in cases of rape, incest, or to avert death of the pregnant woman.5
Contracting with Plans: On February 14, 2013, Lieutenant Governor Mary Taylor sent a letter to the Center for Consumer Information and Insurance Oversight (CCIIO) reiterating the state’s intention to perform plan management activities. The Ohio Department of Insurance (ODI) has the legal authority and operational capacity to oversee certification of Qualified Health Plans (QHPs). ODI will use the System for Electronic Rate and Form Filing (SERFF) to collect, review, and approve plan rate and benefit information. ODI will also ensure continued plan compliance, manage consumer complaints, and oversee decertification of issuers.6
Essential Health Benefits (EHB): The Affordable Care Act (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. Since Ohio has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Community Insurance Company (Anthem Blue Cross Blue Shield)- Blue Access PPO.
In September 2010, the Ohio Department of Insurance received a $1 million federal Exchange Planning grant.
On March 8, 2013, Ohio received approval from CCIIO to perform plan management activities. The federal government will retain control over all other Exchange functions.7
For more information on Ohio’s exchange planning, visit: www.ohioexchange.ohio.gov
1. John Kasich. “Ohio Says No to an Obamacare Health Exchange.” November 16, 2012.http://governor.ohio.gov/exchange.aspx
2. Assist with the first year of planning for design and implementation of a federally mandated American Health Benefit Exchange. August 31, 211. Milliman. http://www.ohioexchange.ohio.gov/Documents/MillimanReport.pdf
3. State of Ohio Health Insurance Exchange Planning: Strategic Architecture Roadmap and Budget Report. September 14, 2011. KPMG. http://www.ohioexchange.ohio.gov/Documents/KPMGBlueprintReport.pdf
4. State of Ohio Health Insurance Exchange Planning: Strategic Architecture Blueprints Report. September 13, 2011. KPMG. http://www.ohioexchange.ohio.gov/Documents/KPMGBlueprintReport.pdf
5. HB 79. 129th General Assembly. Signed December 21, 2011. Enrolled version.http://www.legislature.state.oh.us/bills.cfm?ID=129_HB_7911.
6. Letter from Lieutenant Governor Taylor to Gary Cohen. February 14, 2013.
7. Letter from Gary Cohen to Lieutenant Governor Taylor. March 8, 2013.