Legislation designed to establish the framework for Mississippi’s health care exchange was submitted and debated in the 2011 Session under House Bill 1220 and Senate Bill 2992. (The legislation was not final at publishing time.) 

The final legislation will be known as The Mississippi Health Benefit Exchange Act. The Exchange Act sets forth the necessary framework to comply with the Patient Protection and Affordable Care Act passed by Congress in March, 2010.  The stated purpose of the Exchange Act is to allow a “Qualified Individual”, defined as a non-incarcerated U.S. Citizen or a lawfully present alien who resides in Mississippi, to purchase a “Qualified Health Plan” and to provide for the establishment of a “Small Employer Exchange” to assist small employers in enrolling its employees beginning January 1, 2014.

The stated intent of the Exchange is to “reduce the number of uninsured, provide a transparent consumer-driven marketplace and assist individuals with access to programs, premium assistance, tax credits and cost sharing reductions.”  The Exchange will either be a not-for-profit corporation subject to government oversight (Senate Bill No. 2992) or a state agency (House Bill No. 1220). 

It will subject to the supervision and approval of a Board of Directors and over which the Mississippi Insurance Department will have regulatory authority to issue regulations for the implementation and operation of the Exchange.  In addition, the Mississippi Insurance Department will have the authority to investigate the Exchange and to require periodic reporting. 

The Exchange will be funded initially through the expenditure of State, Federal or private grant funds.  The Exchange is to be self-sustaining by January, 2015, through the assessment of charges or user fees to “Health Carriers.”  In short, “Health Carriers” that participate in the Exchange will be charged for that privilege.       

The Exchange Act sets forth how and by whom the Exchange is to be run and provides what will be available for purchase in the Exchange.  Although the Board of Directors will appoint an Executive Director who will be an employee of the Exchange in charge of administering all of its activities and contracts as well as supervising the staff and advising the Board on all related matters, the Commissioner of Insurance or his designee will be the Chairman of the Board with tie-breaking voting authority only.  The constitution of the Board of Directors varies between the House and the Senate Bills with both providing for 16 members.

            The duties of the Exchange are myriad and include some of the following:

            1.         Providing for a toll free telephone hotline for assistance requests.

            2.         An Internet website where standardized information regarding the Qualified Health Plans will be available. 

            3.         Rating Qualified Health Plans and providing level of coverage information.

            4.         Providing standardized format for options in the Exchange.

            5.         Assist with the purchase and sale of Qualified Health Plans.

            6.         Provide an electronic calculator to allow the individual to determine the actual cost of coverage including premium tax credits and any State or Federal cost sharing provisions. 

A “Qualified Health Plan,” as specifically defined in the Affordable Care Act, is to be made available to “Qualified Individuals” by “Health Carriers” subject to the laws and regulations of Mississippi that will contract to provide the “Qualified Health Plan.”  As mentioned previously, the Exchange will also allow the participation of “Qualified Employers” who are small employers (not more than 50 employees in 2014 and 2015 and not more than 100 employees beginning in 2016). 

The “Qualified Employer” will have to make its full-time employees eligible to participate in the Exchange and can also allow some or all of its part-time employees to participate.  If the “Qualified Employer” has its principal place of business in Mississippi, then it can allow its eligible employees to participate in the Exchange regardless of the employee’s location.  However, if the principal place of business is not in Mississippi, the “Qualified Employer” could still elect to provide coverage for all of its eligible employees who are principally employed in Mississippi.

Another significant and integral duty of the Exchange will be to take applications on all enrollees.  This will allow the Exchange to require Medicaid and CHIP eligible individuals to enroll in those programs rather than a private Qualified Health Plan.  This particular requirement will increase the number of Mississippi residents on the Medicaid and CHIP rolls thus increasing the direct cost of healthcare to the State.  See C. Green, “Medicaid Expansion Under Health Care Reform: Fly Over View,” Mississippi Medical News July 2010.

Cheri  D. Green is a Member of Brunini Grantham Grower & Hewes, PLLC.   Cheri has an extensive insurance practice concentrating on defense of claim issues, coverage litigation and healthcare issues, including ERISA, HIPAA and COBRA. Cheri has written and spoken on various health care related issues, including presentations focusing on insurance reform and employer impacts.  She has a broad litigation practice ranging from commercial litigation, single-plaintiff personal injury and multi-plaintiff mass tort dockets.

 Cheri graduated with a B.P.A. from the University of Mississippi in 1983 Summa Cum Laude  and with a J.D. from the University of Mississippi, Law School in 1986 Cum Laude.

Cheri is one of several of Brunini's attorneys who have been tapped to handle the broad range of issues which will necessarily arise from the Patient Protection and Affordable Care Act. Brunini has developed various resource tools on PPACA including a Newsletter which can be found at its website www.Brunini.com in the Regulatory News section of its home page.

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