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New Hampshire Health Exchange Profile

New Hampshire

Establishing the Exchange

On June 18, 2012, Governor John Lynch (D) signed HB 1297 into law, which prohibits the state from participating in or enabling a state-based health insurance exchange. However, HB 1297 allows for state agencies or departments to “operate specific functions of a federally-facilitated exchange.” Given this authority, newly-elected Governor Maggie Hassan (D) informed federal officials on February 13, 2013 that New Hampshire would pursue a state-federal partnership exchange. The state will retain control over plan management and consumer assistance functions.

In 2011, Governor Lynch allowed two bills opposing the implementation of federal health reform to become law without his signature. SB 148 prohibited the enforcement of the individual mandate in the Affordable Care Act and HB 601 established the Joint Health Care Reform Oversight Committee to oversee all recommendations for legislation implementing federal health reform and required the Insurance Commissioner to obtain approval from the Committee before implementing any provisions.

Contracting with Plans: The New Hampshire Insurance Department (NHID) has legislative authority to certify Qualified Health Plans (QHPs); however, standards and rules relating to QHPs are subject to approval by the Joint Health Care Reform Oversight Committee. NHID will develop a QHP-specific checklist to ensure that QHP certification standards are met and staff will evaluate issuers and plans against the standards to identify which plans will be recommended to the Center for Consumer Information and Insurance Oversight (CCIIO) for certification. Carriers will submit their QHP applications to NHID through the System for Electronic Rate and Form Filing (SERFF) starting March 28, 2013. NHID will develop policies and procedures for quality monitoring of Exchange activities, provided that the state receives federal funding designated for this purpose.

Risk Adjustment, Reinsurance, and Risk Corridors: In December 2012, Governor Lynch indicated that New Hampshire was interested in administering its reinsurance program; however, Governor Hassan intends to use federal services to run the state’s program.

Consumer Assistance and Outreach: HB 1297 authorized the creation of a 12-member Health Exchange Advisory Board, for which the Governor, Insurance Commissioner, and Health and Human Services Commissioner each nominated four individuals who were all confirmed by the Executive Council. The Advisory Board, which began meeting in November 2012, is tasked with representing the interests of businesses and consumers in the exchange.

NHID will work closely with the New Hampshire Department of Health and Human Services (NHDHHS) to design and implement the state’s consumer assistance program, and senior leadership from both agencies will comprise the New Hampshire Consumer Assistance Partnership Exchange Leadership Team. Pending federal grant funding, New Hampshire will hire a consultant to develop policies and procedures for regulation of the Navigator program. NHID will develop the training curriculum and will provide program oversight. NHID also plans to use federal funds to establish a separate In-Person Assistance program and will contract with a consultant to execute program planning and management. NHID plans to release a Request For Proposals (RFP) for the Navigator program consultant in March and an RFP for IPA program implementation in late April or early May.

NHID plans to hire a communications consultant that will assist in developing and implementing outreach and education activities that will promote the Exchange and the IPA program. Communications efforts are expected to include television, radio, print, and online advertising; social media platforms; grassroots and small business outreach; and partnerships with community entities such as libraries, schools, and faith-based organizations.

Essential Health Benefits (EHB): The Affordable Care Act requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. New Hampshire compared potential plans and the legislative Joint Health Care Reform Oversight Committee recommended Matthew Thornton Blue (Anthem BCBS) as the benchmark plan. The state will use the Federal Employee Dental and Vision Plan (FEDVIP) for the pediatric dental and vision supplements.

Exchange Funding

While the State of New Hampshire Insurance Department received a $1 million federal Exchange Planning grant, little of the money was spent. The passage of HB 601 ordered the return of $666,000 in unused funds effective July 2011 and directed the Insurance Commissioner to decline certain exchange planning grant funds in the future. The Department has since requested permission to use the remaining funds; however, the Executive Council declined to authorize the spending in December 2011. In February 2013, the state was awarded a Level One Establishment grant for $894,406 to hire consultants to support plan management operations, including activity management and technical assistance, and to perform preliminary research for consumer assistance functions. Also in February 2013, New Hampshire applied for an $8.6 million Level One Establishment grant to hire contractors to plan and implement consumer assistance operations.

In February 2011, New Hampshire applied for an Early Innovator grant as part of the multi-state New England consortium; however, the state itself was not included as a recipient when the award was granted.

Next Steps

On March 7, 2013, New Hampshire received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a partnership exchange. Final approval is contingent upon the state demonstrating its ability to perform all required Exchange activities on time, complying with future regulations, and achieving expected milestones.

For more information on New Hampshire’s health insurance exchange planning, visit:

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