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Small Business Employee Benefits and HR Blog

CMS Releases SHOP-Only Marketplaces FAQs

Last week the Centers for Medicare and Medicaid Services (CMS) released a set of frequently asked questions on the Small Business Health Options Program (SHOP)-only marketplaces. The SHOP Marketplaces are the small business group health insurance exchanges required in each state per the Affordable Care Act (ACA). SHOP, CMS FAQ on SHOP, ACA

The FAQ comes shortly after the federal government delayed the "employee choice" SHOP option in the federally-run SHOP Marketplace until 2015. Under the employee choice option, a small business could offer insurance through the SHOP Marketplace and allow employees to pick from a variety of insurance plans (like many larger employers do today). The ability for employees to choose from a variety of insurance options will not be available through the federally-run SHOP Marketplace until 2015.

Since the announcement of the delay in this key feature of the SHOP Marketplace, some states have been asking if they can develop their own Marketplace for small businesses while using the federally-run individual Marketplace. A state can do this if they submitted it in their blueprint (their official ACA health insurance exchange planning document).

Here are the FAQs, directly from CMS's release:

May a state operate only a Small Business Health Options Program (SHOP) while the individual market Marketplace is operated as a Federally-facilitated Marketplace (FFM)?

"We will propose through rulemaking that, for 2014, a State that submitted a Blueprint pursuant to §155.105(e) to operate a State-based Marketplace and received conditional approval may request to operate a State-based SHOP while the individual market Marketplace is operated as an FFM. All states would have the same option starting in 2015."

Click here to read the CMS FAQ released May 10, 2013.

Can any state elect to operate a state-based SHOP in 2014?

"We intend to propose through rulemaking that only states that have submitted blueprints and received conditional approval to operate as a State-based Marketplace in 2014 are eligible to submit a request to HHS to operate only a state-based SHOP in 2014."

Click here to read the CMS FAQ released May 10, 2013.

Will the requirements for a state to operate a state-based SHOP while the individual market Marketplace is operated as a FFM be different for 2015?

"We intend to propose through rulemaking that states wishing to operate only a state-based SHOP in 2015 or beyond be required to submit a Blueprint that is being specifically developed for the State-based SHOP/individual market FFM arrangement."

Click here to read the CMS FAQ released May 10, 2013.

If a state elects to operate a state-based SHOP only, will the state be required to operate a navigator program for the SHOP? If so, are the requirements for the state-based SHOP-only navigator programs the same?

We intend to propose through rulemaking that, if a state operates only a state-based SHOP, the SHOP must have a navigator program, consistent with the statute. We also intend to propose that the state may choose to limit navigators in a SHOP-only navigator program to consumer outreach and education activities. The proposed rulemaking would also provide that the FFM would operate a navigator program in the individual market FFM in states that operate only a state-based SHOP.

Click here to read the CMS FAQ released May 10, 2013.