Americans for Prosperity, a conservative think tank and grass roots organization, voiced its concern that states will not have enough control over HIX to meet local market needs. It said CMS created significant changes that would limit a state's ability to alter or control its own HIX without CMS approval. According to the comments, those changes include certification procedures and enrollment processes as well as IT systems. The group echoed a common concern that CMS has not given states enough time to establish exchanges.
Several states, including Louisiana, Ohio, and Oklahoma, submitted comments. Ohio officials asked for more flexibility in the federal-state partnership model. "States are more than capable and should have the ability to customize their state-based exchange by choosing additional options that the state is able to mange, while leveraging federal coordination of functions that make more sense handled nationally." Oklahoma officials questioned whether CMS should limit how and when to charge user fees. "Federal policy should not dictate how user fees can be handled at the state level and further restrictions on how the state may assess user fees are unnecessary. Additionally, the exchange may wish to collect assessments on a more regular basis, such as monthly."
Louisiana officials noted that the rule requires an exchange to verify annual household income information and current household income information. But since few data sources provide such real time information, it asked CMS to define what an exchange can accept as "current household income."
The National Association of Medicaid Directors asked federal agencies to make reporting and business process as easy as possible for states and consumers. "States believe they should not be asked to collect or report data that does not result in any substantial difference in the determination of coverage."