With the Dec. 14 deadline on health insurance exchanges, states were required to provide a blueprint of their plans to the Department of Health and Human Services for how they will create their state-based health insurance exchanges.About half of the states have decided to surrender control to the federal government to build an exchange for them.

HHS has set deadlines for stages in the development of the online marketplaces to be sure that states will be ready to offer enrollment in health coverage starting in October 2013 and be operational Jan.1, 2014.

With the Dec. 14 deadline on health insurance exchanges, states were required to provide a blueprint of their plans to the Department of Health and Human Services for how they will create their state-based health insurance exchanges.About half of the states have decided to surrender control to the federal government to build an exchange for them.

HHS has set deadlines for stages in the development of the online marketplaces to be sure that states will be ready to offer enrollment in health coverage starting in October 2013 and be operational Jan.1, 2014.

To date, 18 states plus the District of Columbia have said that they intend to build their own exchange, while six have decided on a partnership model with the federal government. States participating in a partnership exchange must submit their blueprints by Feb. 15, 2013.

States will have the flexibility to move to state-based exchanges in the future, said Sarabeth Zemel, program manager for the National Academy for State Health Policy.

“The blueprint demonstrates that a state will meet all the legal and operational requirements for the state-based exchange model and operational readiness to engage in its exchange activities,” she said in a Dec. 13 online briefing.

Of the remaining, 24 states will opt for a federally-facilitated exchange and two, Florida and Utah, have not decided, according to the Kaiser Family Foundation health reform tracker. Utah is considering using its current exchange, which was created previously.

Sebelius had extended the blueprint deadline by one month to accommodate primarily Republican governors, who were waiting until the election outcome to decide whether to move ahead on the exchanges. Many Republican-led states have defaulted to the federally built exchange.

Sebelius announced last week that six states -- Colorado, Connecticut, Maryland, Massachusetts, Oregon and Washington -- had received conditional approval for their state-based health insurance exchange plans. She reiterated that “As both a former governor and state insurance commissioner, I believe states are in the best position to make decisions about their health insurance marketplaces.” 

States that are developing their own exchanges must get conditional approval of their detailed plans by Jan. 1, 2013, indicating that it will be operationally ready for open enrollment beginning Oct. 1, 2013. “That means that a state’s IT system and consumer assistance needs to be up and running then,” Zemel said.

For Maryland Lt. Gov. Anthony Brown, who leads the state’s healthcare reform efforts, the conditional approval is an important milestone for the Maryland Health Benefit Exchange. 

“Our progress has been the result of insurance producers, carriers, third-party administrators, healthcare providers, advocates, and consumers coming together to build a marketplace that will best meet the needs of individuals and small businesses throughout Maryland,” said Brown in an announcement.

He cited the cooperation of Maryland’s congressional delegation and the state General Assembly “to maximize the Affordable Care Act in order to make Maryland the healthiest state in the nation.”