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Health Insurance Exchanges in California

            The state of California has enacted legislation to set up a state based health insurance exchange as required by the Patient Protection and Affordable Care Act.  The California law authorizes the creation of two separate exchanges for the individual market and for small business.  However, both of these exchanges will be administered by one Board.1  The exchange will be structured as an independent public entity unaffiliated with any agency or department.2  The law also outlines the composition and duties of members of the exchange Board.  Among the Board’s duties are maintaining a website that includes qualified health plans and their ratings, identifying eligibility for state subsidies, determining eligibility for premium tax credits, and establishing a Navigator program.3  In addition, the Board is required to maintain records and submit an annual report to the Department of Health and Human Services as well as to the state’s Legislature and Governor.4  The Board maintained Website must allow enrollees and prospective enrollees of QHPs to obtain standardized comparative information on those plans.5 The Board must also ensure that the enrollment process for the Exchange is coordinated with state and local entities that administer other health care programs, including Medi-Cal and Healthy Families.6


            The Exchange must provide, in each region of the state, a choice of Qualified Health plans at each of the four levels of coverage, defined by the federal law.7  Qualified Health plans are required to submit specific plan information to the Board as well as to the state under the law.8



  • 1. Cal. Gov. Code §100502
  • 2. Cal. Gov. Code §100500(a)
  • 3. Cal. Gov. Code §100500(d); §100504§
  • 4. Cal Gov. Code §100503
  • 5. Cal Gov. Code §100502(c)
  • 6. Cal Gov. Code §100503(a); Cal Gov. Code §100503(b)
  • 7. Cal Gov. Code §100503(d)
  • 8. Cal Gov. Code §100502


Health Insurance Exchanges in California

Subtopic Statute/Regulation Description
Brief description of each state's Exchange: Structure California Health Benefit Exchange Participation and Program Requirements – Cal. Health & Safety Code § 1366.6 The state of California has established regulations governing health service plan participation within the health benefit exchanges enacted under the...
Authorizing legislation Establishment of the California Health Benefit Exchange : Governance, Duties and Administration, and Receipt and Expenditure of Funds – Cal. Gov't Code § 100500 The state of California has established the California Health Benefit Exchange as an independent public entity.  The Exchange is governed by a...