State Health Exchanges


The APA has established this webpage to guide its DBs and their members as they work with their states to develop state health exchanges, ensuring the exchanges include benchmark plans that are based on the state’s current mental health coverage and are  in compliance with the parity requirements of MHPAEA.

Under the Affordable Care Act all states are required to have established health insurance exchanges (or have them established by the Federal government if they fail to do so) by January 1, 2014. The qualified health plans (QHPs) that will be offered by the exchanges are required to cover essential health benefits (EHBs) in ten categories, one of which is mental health (including substance abuse disorders).

Because of the requirement that all plans offer a mental health benefit, the plans will have to comply with the terms of the 2008 mental health parity law (MHPAEA). States have been assigned the task of designing the EHBs that will be offered by the plans in their exchanges, with the stipulation that these benefits may not fall below those provided by a benchmark plan offered in the state.  HHS has said the EHB benchmark plan a state may use must be either:

  • the largest plan by enrollment in any of the three largest small group insurance plans in the state’s small group market;
  • any of the largest three state employee health benefit plans by enrollment;
  • any of the largest three Federal Employee Health Plan options by enrollment; or
  • the largest insured commercial non-Medicaid HMO operating in the state.  

To contact the Division of Advocacy staff for assistance and to provide feedback as you work through establishing the exchanges, email us at or leave a message 866.882.6227.

Latest Developments

HHS releases Final Rule: Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation [2.20.13]
February 7, 2013:   Federal Health Insurance Marketplaces: A Conversation with CCIIO Director Gary Cohen [2.7.13]


Alliance for Health Reform
Health Insurance Exchanges: Can States and the Federal Government Meet the Deadline? July 27 2012.  Links available for all briefing materials, speaker presentations, source materials and offsite briefing documents.

APA on the Issues
Health Reform and Mental Health Parity
ACA Health Insurance Exchanges: A Primer [Webinar presentation (slides only); Member log-in required] [2.12.13]
APA Memo on Key Proposed Rules on ACA Implementation from Obama Administration [11.20.12]

The Commonwealth Fund
Implementing the Affordable Care Act: Key Design Decisions for State-Based Exchanges [Jul 2013]

Health Insurance Market Reforms
Healthcare in your state

Kaiser Foundation
State Health Facts

National Academy for State Health Policy
Publications:  Health Insurance Exchanges

National Conference of State Legislatures
State Actions to Address Health Insurance Exchanges

State Progress on Essential Health Benefits