Oklahoma Launches State-Based Health Insurance Marketplace for 2028
The Oklahoma Insurance Department has announced plans to establish a state-based health insurance marketplace for the 2028 open enrollment period under the Affordable Care Act. Currently relying on the federal marketplace platform, HealthCare.gov, this transition will position Oklahoma alongside 20 other states and the District of Columbia, managing its own health insurance exchange with an independent website and contact center.
The shift to a state-managed marketplace is facilitated by House Bill 1512, spearheaded by Rep. Mark Tedford and Sen. Lonnie Paxton. This legislation empowers the insurance commissioner to create a state-based exchange and establishes a revolving fund for its management. By operating its own platform, the Oklahoma Insurance Department aims to retain and reinvest revenues that were previously directed to federal coffers, enhancing regulatory compliance and oversight. Ashley Scott, Deputy Commissioner for External Affairs, has been appointed as the director of the marketplace. Scott remarked, "We are taking back control of our individual market and will better serve Oklahomans across the state with this effort."
Transition to State-Based Marketplace
Initially, Oklahoma will function as a state-based exchange using the federal platform, with the transition beginning May 1. For the 2026 and 2027 coverage years, residents will continue utilizing HealthCare.gov, while Oklahoma manages public engagement, community assistance programs, health plan management, and operates a consumer hotline. By November 2027, the state-based exchange will be fully operational, allowing direct enrolment for 2028 coverage through improved regulatory compliance requirements.
Insurance Commissioner Glen Mulready, a long-time advocate for a state-based exchange, highlighted benefits such as enhanced data reporting on enrollment and efficient risk management to combat fraud. He cited past issues where individuals were unknowingly enrolled in zero-premium plans, emphasizing that state control would facilitate quicker and more direct responses to underwriting inaccuracies.
State Innovation Waiver and Reinsurance Program
The Oklahoma Insurance Department also plans to apply for a Section 1332 State Innovation Waiver to introduce a state reinsurance program beginning in 2028. Such a program is designed to stabilize the insurance market by providing financial support to insurers for high-cost claims, thereby maintaining more competitive premium costs and fostering a healthier payer-provider ecosystem. As of May 2024, CMS has approved reinsurance programs for 17 states, which Oklahoma aims to join to further its regulatory and compliance efforts.
This strategic move signals Oklahoma’s commitment to autonomously and effectively manage its health insurance industry, ensuring better oversight and service to its residents while actively participating in regulatory and market improvements.