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The Centers for Medicare and Medicaid Services has conditionally approved seven additional states to operate a health insurance exchange under provisions of the Affordable Care Act.

The newly approved states are California, Hawaii, Idaho, Nevada, New Mexico, Vermont and Utah. Further, Arkansas has received conditional approval to operate an exchange that will be built in partnership with the federal government.

Nineteen states and the District of Columbia now have received conditional federal approval to fully or partially operate their exchanges. Other states previously approved include Colorado, Connecticut, Kentucky, Massachusetts, Maryland, Minnesota, New York, Oregon, Rhode Island and Washington to operate their own HIX, and Delaware to partner with the federal government.

Many of the remaining states have Republican governors resistant to the idea of building an exchange or outright hostile, although some state executives initially cool to the idea changed their minds following the November elections and as deadlines loomed. States had until Dec. 14, 2012, to decide their HIX strategy. Those states not building their own have until Feb. 15 to decide if they want a state-federal partnership, or let the federal government build and run the exchange. A partnership gives states some say in the standards that insurers must meet to sell benefit plans through the exchange.

CMS has issued new guidance on the partnership arrangement for health insurance exchanges, available here.