The Department of Health and Human Services has award a new round of grants to five states and the District of Columbia as they build health insurance exchanges mandated under the Affordable Care Act.

Following grants used for exchange planning activities, Arkansas, Colorado, Kentucky, Massachusetts and Minnesota now have received one-year, Level One grants to build an exchange. The District of Columbia has received a multi-year Level Two grant to continue to expand functionalities of its exchange. To date, 49 states, the District of Columbia and four territories have received planning grants, and 34 states and D.C. are in the building process.

For your consideration: Guidance on State Insurance Exchanges, Medicaid Expansion Plans

The reform law requires states to have an operational exchange by 2014 or the federal government will implement an exchange. Some states, particularly those with Republican governors, are waiting until after the November elections to proceed with exchanges.

The federal government has issued flexible policies this year to ease state concerns about the exchanges. For instance, states may apply for grants through the end of 2014 and use the funds through the initial start-up year.

In July, the Centers for Medicare and Medicaid Services announced it will give states free rein to implement additional information technologies to support health insurance exchanges and the expansion of Medicaid--before they even commit to going through on those projects, and with no payback of funds required if they don’t.

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