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Health insurance marketplace: West Virginia's path to becoming a partner in the
federally-facilitated
marketplace

Client Description

West Virginia Offices of the Insurance Commissioner (OIC), Health Policy

Problem/Issue

The state was uncertain which Health Insurance Marketplace (HIM) model to pursue in order to protect the best interests of its citizens while at the same time complying with the Affordable Care Act (ACA). The ACA requires states to have an operational individual and small business “Marketplace” in place by January 1, 2014. At the time of our engagement, states had three choices, including:

  • Building a State-Based Marketplace (SBM)
  • Joining the Federally-Facilitated Marketplace (FFM)
  • Entering into a State Partnership with the federal government in the FFM 

BerryDunn's Solution/Approach

BerryDunn’s health and human services consulting team was engaged by the OIC in mid-2011 to perform planning activities to assist state leadership with decision making. Our ACA experts provided critical analytical input and recommendations to the state as it evaluated Marketplace models. The BerryDunn team:

  • Developed an HIM Information Technology (IT) strategic plan
  • Performed a call center analysis
  • Drafted a request for information (RFI) for an HIM IT system and analyzed vendor responses
  • Established a business plan and financial sustainability model 

Outcomes

In conjunction with the state’s independent planning activities, our team was able to assist West Virginia through the difficult process of weighing the pros and cons of each Marketplace model. Based on key factors, such as the potential difficulty for an SBM to be financially self-sustaining when federal money is no longer available in 2015, the state ultimately decided to pursue a Partnership with the federal government. This approach allows the state to reduce its risk, minimize the financial impact on the state and its stakeholders, provide continued health insurance regulatory authority, and offer better service and protection to consumers. The state is also well positioned should it choose to transition to an SBM in future years.

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