Technical Implementation Letters

Administration officials issue letters requesting information, issuing guidance, announcing progress to date, and other implementation efforts.
State Letters on Exchanges

Under the Affordable Care Act, HHS is required to certify states' plans to run their own Exchanges. A number of states have signaled their intent to create their own state-based Exchange, or a state partnership Exchange in the letters below. A state may submit a letter of intent and an application to operate its own Exchange by December 14, 2012. States may also apply to operate their Exchange in partnership with the federal government by February 15, 2013. And a state may apply at any time to run an Exchange in future years. Learn more about these new health insurance marketplaces and how they can help you. - Opens in a new window

• November 15, 2012: Letter to Governors on Exchange Declaration Deadline (PDF) (PDF - 527 KB)
• November 9, 2012: Letter to the Governors on Exchange Blueprints (PDF) (PDF - 748 KB)
  

Note: People using assistive technology may not be able to fully access information in these files. For assistance, please email healthcareweb@hhs.gov.

State Partnership Exchange Letters

Arkansas

• December 12, 2012: Letter from the Governor of Arkansas on State Partnership Exchanges (PDF) (PDF - 527 KB)

Delaware

• November 14, 2012: Letter from the Governor of Delaware on State Partnership Exchanges (PDF) (PDF - 748 KB)

Illinois

• October 16, 2012: Letter from the Governor of Illinois on State Partnership Exchanges (PDF) (PDF - 105 KB)

Iowa

• December 14, 2012: Letter from the Governor of Iowa on State Partnership Exchanges (PDF)(PDF - 264 KB)

Michigan

• January 22, 2013: Letter from the Governor of Michigan on State Partnership Marketplace (PDF) (PDF - 305 KB)

New Hampshire

• February 13, 2013: Letter from the Governor of New Hampshire on State Partnership Marketplace (PDF) (PDF- 165 KB)

West Virginia

• February 15, 2013: Letter from the Governor of West Virginia on State Partnership Marketplace (PDF) (PDF- 165 KB)

State-Based Exchange Letters

California

• July 10, 2012: Letter from the Governor of California on State-Based Exchanges (PDF) (PDF - 344 KB)

Colorado

• October 8, 2012: Letter from Governor of Colorado on State-Based Exchanges (PDF) (PDF - 33 KB)
• July 6, 2012: Letter from the Governor of Colorado on State-Based Exchanges (PDF) (PDF - 42 KB)

Connecticut

• July 10, 2012: Letter from the Governor of Connecticut on State-Based Exchanges (PDF) (PDF - 244 KB)

District of Columbia

• November 15, 2012: Letter from the Mayor of the District of Columbia on State-Based Exchanges (PDF) (PDF - 86 KB)
• August 8, 2012: Letter from the Mayor of the District of Columbia on State-Based Exchanges (PDF) (PDF - 946 KB)
  

Hawaii

• June 7, 2012: Letter from the Governor of Hawaii on State-Based Exchanges (PDF) (PDF - 565 KB)

Idaho

• December 14, 2012: Letter from the Governor of Idaho on State-Based Exchanges (PDF) (PDF - 529 KB)

Kentucky

• November 14, 2012: Letter from the Governor of Kentucky on State-Based Exchanges (PDF) (PDF - 246 KB)
• July 10, 2012: Letter from the Governor of Kentucky on State-Based Exchanges (PDF) (PDF - 64KB)

Maryland

• October 9, 2012: Letter from Governor of Maryland on State-Based Exchanges (PDF) (PDF - 38 KB)
• July 10, 2012: Letter from the Governor of Maryland on State-Based Exchanges (PDF) (PDF - 53 KB)
  

Massachusetts

• July 10, 2012: Letter from the Governor of Massachusetts on State-Based Exchanges (PDF) (PDF - 950 KB)

Minnesota

• November 15, 2012: Letter from the Governor of Minnesota on State-Based Exchanges (PDF) (PDF - 114 KB)
• July 10, 2012: Letter from the Governor of Minnesota on State-Based Exchanges (PDF)(PDF - 2.5 MB)
  

Nevada

• December 14, 2012: Letter from the Governor of Nevada on State-Based Exchanges (PDF) (PDF - 35 KB)
  

New Mexico

• December 13, 2012: Letter from the Governor of New Mexico on State-Based Exchanges (PDF) (PDF - 39 KB)

New York

• November 15, 2012: Letter from the Governor of New York on State-Based Exchanges (PDF) (PDF - 112 KB)
• July 9, 2012: Letter from the Governor of New York on State-Based Exchanges (PDF) (PDF - 52 KB)
  

Oregon

• July 6, 2012: Letter from the Governor of Oregon on State-Based Exchanges (PDF) (PDF - 530 KB)

Rhode Island

• July 5, 2012: Letter from the Governor of Rhode Island on State-Based Exchanges (PDF) (PDF - 435 KB)

Utah

• December 14, 2012: Letter from the Governor of Utah on State-Based Exchanges (PDF) (PDF - 952 KB)

Vermont

• July 9, 2012: Letter from the Governor of Vermont on State-Based Exchanges (PDF) (PDF - 71 KB)

Washington

• July 31, 2012: Letter from the Governor of Washington State-Based Exchanges (PDF) (PDF - 47 KB)
• July 10, 2012: Letter from the Governor of Washington on State-Based Exchanges (PDF) (PDF - 62 KB)
  

Marketplace Plan Management Letters

Kansas

• February 15, 2013: Letter from Kansas (PDF) (PDF - 218 KB)
• March 8, 2013: CMS Letter to Kansas (PDF) (PDF - 457 KB)
  

Maine

• March 18, 2013: Letter from Maine (PDF) (PDF - 379 KB)
• March 29, 2013: CMS Letter to Maine (PDF) (PDF - 833 KB)

Montana

• February 26, 2013: Letter from Montana (PDF) (PDF - 44 KB)
• March 8, 2013: CMS Letter to Montana (PDF) (PDF - 452 KB)
  

Nebraska

• February 20, 2013: Letter from Nebraska (PDF) (PDF - 668 KB)
• March 8, 2013: CMS Letter to Nebraska (PDF) (PDF - 464 KB)
  

Ohio

• February 14, 2013: Letter from Ohio (PDF) (PDF - 46 KB)
• March 8, 2013: CMS Letter to Ohio (PDF) (PDF - 461 KB)
  

South Dakota

• March 11, 2013: Letter from South Dakota (PDF) (PDF - 553 KB)
• March 29, 2013: CMS Letter to South Dakota (PDF) (PDF - 452 KB)
  

Virginia

• February 14, 2013: Letter from Virginia (PDF) (PDF - 553 KB)
• March 8, 2013: Letter from Virginia (PDF)(PDF - 164 KB)
• March 29, 2013: CMS Letter to Virginia (PDF) (PDF - 434 KB)

Letters from 2010, 2011, and 2012 Related to the Implementation of the Affordable Care Act

• Letter from Secretary of Health and Human Services Kathleen Sebelius and Secretary of Education Arne Duncan to the Governors (PDF) (PDF - 58 KB) (August 12, 2011)
• Letter from the Center for Consumer Information and Insurance Oversight to Superintendent Kofman Regarding the State of Maine's Request for Adjustment to Medical Loss Ratio Standard (PDF) (PDF - 411 KB) (March 8, 2011)
• Letter from Departments of Health and Human Services, Labor, and Treasury to House Speaker John Boehner Regarding the Price of Repealing the Affordable Care Act (PDF)(PDF - 462 KB) (January 5, 2011)
• Letter from HHS Secretary Kathleen Sebelius to Insurance Commissioners Regarding Notice of Proposed Rulemaking on Rate Review (PDF)(PDF - 48 KB) (December 21, 2010)
• Letter from CalPERS to HHS Secretary Kathleen Sebelius Regarding the Affordable Care Act Implementation (PDF)(PDF - 94 KB) (December 10, 2010) Persons using assistive technology may not be able to fully access information in this file. For assistance, please email healthcareweb@hhs.gov.
• Letter from HHS Secretary Kathleen Sebelius to Consumer Groups Regarding Supplemental Guidance on Consumer Notices and Sale of New Business (PDF) (PDF - 162 KB) (December 9, 2010) Persons using assistive technology may not be able to fully access information in this file. For assistance, please email healthcareweb@hhs.gov.
• Cover memo to States from HHS Secretary Kathleen Sebelius on Exchange Guidance (PDF) (PDF - 148 KB) (November 18, 2010) Persons using assistive technology may not be able to fully access information in this file. For assistance, please email healthcareweb@hhs.gov.
• Cover Memo to States from OCIIO and CMS on IT for Exchanges and Medicaid (PDF) (PDF - 203 KB) (November 3, 2010)
• Letter from Chairman Carter II to Secretary Sebelius Regarding How the IBEW Health & Welfare Trust Fund Supports ERRP (PDF) (PDF - 28 KB) (September 30, 2010) Persons using assistive technology may not be able to fully access information in this file. For assistance, please email healthcareweb@hhs.gov.
• Letter from CEO Nancy Brown to Secretary Sebelius Regarding the American Heart Association's Support for ERRP (PDF) (PDF - 70 KB) (September 30, 2010)
• Letter from Mayor Cownie to Secretary Sebelius Regarding Des Moines, Iowa's Support for ERRP (PDF) (PDF - 189 KB)(September 30, 2010)
• Letter from Mayor Cashell Sr. to Secretary Sebelius Regarding Reno, Nevada's Support for ERRP (PDF) (PDF - 249 KB) (September 30, 2010)
• Letter from Mary Miller, Ass. Director of Human Resources, to Secretary Sebelius Regarding Olathe, Kansas's Support for ERRP (PDF) (PDF - 22 KB) (September 30, 2010)
• Letter from HHS Secretary Sebelius and Treasury Secretary Timothy Geithner to Sen. Harry Reid Regarding Senate Amendments 4595 and 4596 (PDF) (PDF - 221 KB) (September 13, 2010) Persons using assistive technology may not be able to fully access information in this file. For assistance, please email healthcareweb@hhs.gov.
• Rate Review letter from Secretary Sebelius to Governors and State Insurance Commissioner (PDF)s (PDF - 23 KB) (June 7, 2010)
• State High Risk Pool cover letter from Jay Angoff, Director of the Office of Consumer Information and Oversight (PDF)(PDF - 24 KB) (May 10, 2010)