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The U.S. Department of Health and Human Services (HHS) must make a determination on or before January 1, 2013, that a state will in fact have an exchange in operation by 2014 and that the exchange meets the requirements of the Affordable Care Act (ACA) and HHS guidance. In a letter dated November 15, 2012, Secretary Sebelius indicated that states may submit both a letter of intent and an application to operate its own exchange by December 14. If a state elects not to operate an exchange, or if the HHS determines that the state will not be able to have an exchange operational by 2014 that meets the law’s requirements, the ACA gives the HHS the authority to establish and operate such exchange within the state.
Legislation establishing a state-based health insurance exchange failed in Missouri’s 2011 and 2012 legislative sessions. In the absence of exchange legislation, Missouri’s Health Insurance Exchange Coordinating Council moved forward with exchange planning.
In 2010, Governor Jeremiah Nixon allowed a law prohibiting health insurance exchanges established in the state from offering insurance policies or riders that provide abortion coverage except in cases of life endangerment of the pregnant woman to become law without his signature (SB 793).
While the State has received a $1 million Exchange Planning grant and a $20.8 million federal Level One Establishment grant, the Senate Interim Committee has yet to approve spending the funds.
Governor Nixon has said the State will not run its own exchange but he did not take a position on a federal partnership. The state legislature may take up the issue early in 2013.