Health Reform: Health Benefits Exchange and Insurance Oversight Workgroup

Workgroup Overview

The Affordable Care Act (ACA) includes provisions to create a health benefit exchange (HBE). The HBE will help individuals and small businesses purchase coverage by providing standardized information to help consumers compare plans. In addition, some people will be eligible for subsidies to help them purchase health insurance coverage. Individuals will be able to apply for health insurance coverage online. Those who qualify for public coverage (ie, Medicaid or NC Health Choice) will be enrolled into the public insurance programs; and those who qualify for a subsidy will receive help paying for private coverage offered through the HBE.

The ACA also includes new consumer protections for individuals with private health insurance coverage. For example, starting this year, parents can keep their children on their health insurance plans until the child reaches age 26. In 2014, insurance companies will no longer be able to deny coverage or charge individuals more due to their pre-existing health problems. The Health Benefit Exchange and Insurance Oversight Workgroup will examine these provisions to ensure that the decisions made about implementing the exchange- and insurance-related provisions of the PPACA serve the best interests of the state as a whole.

As part of this effort, the Health Benefit Exchange and Insurance Oversight Workgroup will work to:

• Help develop the Health Benefit Exchange


• Provide guidance on insurance oversight


• Coordinate enrollment between Medicaid and the Exchange

Information about the Affordable Care Act

General information about health reform including presentations, a summary of funding opportunities, and helpful links is available here.

Workgroup Background

The overall goal of this effort is to identify the decisions the state must make in implementing health reform. The Advisory Group and workgroups also plan on identifying potential funding opportunities to ensure that we are aware of, and take advantage of, any potential funding opportunity that will help us improve population health, access to care, and health care quality. We want to build on North Carolina's existing strengths and ensure that the decisions made in implementing the federal legislation serve the best interests of the state as a whole.

The effort will be led by Lanier Cansler, Secretary of the NC Department of Health and Human Services, and Wayne Goodwin, Commissioner of the NC Department of Insurance. The new federal health reform legislation will have significant impact on the way that health care is delivered in North Carolina.

To help the state prepare for these changes, eight different workgroups are being established:Prevention, Safety Net, Health Professional Workforce, Health Insurance Exchange and Insurance Oversight, Medicaid, New Models of Care, Quality, Fraud and Abuse.

This planning effort will be led by an Overall Advisory Group that will help coordinate the work of each of these workgroups. Each workgroup will meet approximately one time per month from August 2010-August 2011 to review specific sections of the legislation and examine any new funding opportunities that are made available as part of this legislation.