Federal & State Regulations | State insurance exchanges - Wisconsin

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Summary of differences between federal and state regulations

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.

The Federal government awarded Wisconsin two grants to build its Affordable Insurance Exchange:

1. The State Planning Grant, awarded September 30, 2010, in the amount of $999,873; and

2. The Early Innovator Grant, awarded February 16, 2011, in the amount of $37,757,266.

In January 2012, Wisconsin Gov. Scott Walker announced that he will not pursue the implementation of a health insurance exchange and returned the Early Innovator Grant funding to the federal government. On November 16, 2012, Governor Walker stated that he will cede control of a health insurance exchange to the federal government.

On April 5, 2012, Wisconsin enacted a law prohibiting any qualified health plan operating in the state and offered through an American health benefit exchange from covering any abortion which is not directly and medically necessary to save the life of the woman or in a case of sexual assault or incest.