State Exchange Models
A state’s Exchange model determines which online system(s) issuers must use to submit their QHP Application, who performs the certification, and who sends certification notifications.
State Exchange Models
| Exchange Model | Who performs functions? | Where do consumers apply & enroll? | Submission System* |
| Federally-facilitated Exchange (FFE) | HHS performs all Exchange functions | HealthCare.gov | HIOS MPMS Module & SERFF (for rate filing information)** |
| State Performing Plan Management Functions | States administer in-person consumer assistance functions; HHS performs remaining Exchange functions | HealthCare.gov | SERFF & HIOS MPMS Module |
| State-based Exchange on the Federal Platform (SBE-FP) | States perform all Exchange functions but use the FFE IT platform | HealthCare.gov | SERFF & HIOS MPMS Module |
| State-based Exchange (SBE) | States perform all Exchange functions | Exchange websites established & maintained by the states | State-specific system |
| States Not Enforcing Market-Wide Reforms (MO, OK, TX, WY) | These states have notified CMS that they do not have the authority to enforce or are not otherwise enforcing the Affordable Care Act market reform provisions. Issuers must submit form filings to CMS for review. | HealthCare.gov | Contact formfiling@cms.hhs.gov for details on requirements for form filing in these states. |
* All issuers required to submit a Plan ID Crosswalk Template should submit this template via the Plan Management (PM) Community.
** States without an Effective Rate Review Program and states that do not have access to SERFF should submit rate filings into the HIOS Unified Rate Review Module.