Background

Senate Bill 972 (2023) requires the Oregon Health Authority (OHA) to transition the Marketplace from a state-based marketplace using the federal platform (SBM-FP) to a state-based marketplace (SBM) using its own technology in time for open enrollment for plan year 2027. Specifically, OHA is required to procure and administer an information technology platform or service and call center, separate from the federal platform and call center, to provide electronic access to the health insurance exchange in this state by November 1, 2026. The Oregon Health Insurance Marketplace helps people in Oregon access affordable, high-quality health insurance through enrollment in private health insurance and federal subsidies during annual open enrollment and special enrollment periods. A state-based marketplace will give us more flexibility to make open enrollment fit the unique needs and budgets of people across Oregon. Transitioning to a state-based marketplace model will allow us to incorporate more meaningful community input into process and procedure changes.

Since the last update in January 2024, the SBM Transition Project team has been diligently working to complete deliverables including:

• Selection of Independent Quality Management Services (iQMS)
• Market Analysis
• Requirements and Gap Analysis

On April 11, 2024, the project was approved by the Department of Administrative Services Enterprise Information Services to pass through Stage Gate 2.

Market Analysis The project team finalized the “Vendor Introduction” document and sent it to 7 solution vendors, inviting them to participate in the informational interviews for the market analysis. These informational interviews took place the first and second weeks of January. The research has confirmed that the overall scope of the Marketplace’s needs and requirements can be met by the features of the software as a service (SaaS) solutions currently in use by other states, including the successful transitions and migrations that have already occurred in Nevada, New Mexico, New Jersey, Pennsylvania, Maine, and Kentucky. These solutions are offered by vendors as fully hosted and maintained repeatable SaaS solutions that are configured for a state’s individual needs. The baseline requirements can be summarized as, “replicate all current functionality that HealthCare.gov performs for Marketplace plan application, eligibility, and enrollment”, and vendors have confirmed meeting that criteria. Anything the Marketplace has so far discussed as an “improvement or innovation” to the current HealthCare.gov business model has been discussed by the vendors as a standard “feature” of their systems – existing functionality can be configured for a wide range of business rules that may vary between states, but the business rules are already in place and well understood by vendors.

Partner Engagement Partner engagement activities took off in Jan. 2024 with a partner survey and listening sessions to gather feedback on requirements. A report of results (orhim.info/49aZFkC) has been posted to the SBM Transition Project website. Insurance carriers, community partner organizations who provide application assistance, and insurance agents/brokers have been invited to participate in quarterly listening sessions. These sessions are scheduled to take place in Jan., April, July, and Oct. through Jan. 2027 and will be used as a place to gather feedback throughout the project lifecycle. Additionally, the quarterly SBM Transition Project newsletter kicked off in Jan. 2024 (orhim.info/3ILls7R). The Marketplace is encouraging all interested individuals to register for the newsletter at orhim.info/sbmupdates.

The table below contains a comprehensive list of deliverables and milestones, along with their corresponding start dates, due dates, and current status.

• Visit orhim.info/SBMtransition
• Email marketplace.sbmproject@odhsoha.oregon.gov