Texas: A Federally-facilitated Health Insurance Marketplace
A central component of the Affordable Care Act is the establishment of a Health Insurance Marketplace (formerly known as an Exchange) in each state.
Each state is expected to have its Marketplace up and running by the beginning of the "open enrollment period," October 01, 2013. Coverage is slated to go into effect on January 01, 2014.
State-based Marketplace: A state can establish and operate its own Marketplace.
Federally-facilitated Marketplace: States which do not select either of the above options will default to a federally-facilitated program in which the federal DHHS assumes full responsibility for the establishment and operation of the Marketplace in that state.
To date, 26 states -- including Texas -- have defaulted to a Federally-facilitated Marketplace. This means that the Texas Health Insurance Marketplace will be operated entirely by the federal government. The federal DHHS will collaborate with the Texas Health and Human Services Commission (HHSC) to properly coordinate the referral of applicants between the Texas Health Insurance Marketplace and the commission’s own application system for Medicaid and CHIP (which Texas will retain control over).
Texas has the option to move to a State Partnership or State-based Marketplace at any time, and can do so through either legislation or an executive order from the Office of the Governor. The federal government has advised that it will take approximately a year for a state to complete the necessary preparation, planning, and readiness training to move from a federally-facilitated model to a State-based Marketplace.