States with state-based public health insurance exchanges may still have about $703 million of their $1.4 billion in federal information technology grant money available.
See also: PPACA: HHS Offers Exchange Grants
The states that were HealthCare.gov states in 2014 still have about $300 million of the $375 million in federal exchange IT spending authorization power that they were allocated.
Valerie Melvin, a director at the U.S. Government Accountability Office (GAO), gives information about the public exchanges’ federal IT grant resources in a report on how the U.S. Department of Health and Human Services (HHS) has overseen states’ efforts to build Patient Protection and Affordable Care Act (PPACA) exchange programs.
Some states have refused to help build or run PPACA exchanges. Some have built and continued to run state-based exchanges.
Others actively decided, before the exchange system opened on Oct. 1, 2013, to let HHS handle or part or all of their exchange operations.
See also: Arizona governor rejects state-run PPACA health exchange
Three states — Nevada, New Mexico and Oregon — tried to run their own exchange enrollment systems in 2014 but ended up using the HealthCare.gov system for enrollment in 2015.
GAO investigators found that the Centers for Medicare & Medicaid Services, the arm of HHS responsible for exchange construction, had serious problems with managing states’ exchange projects and use of the PPACA grant money provided by HHS.
See also: Watchdog warns states may be misusing PPACA funds
“Roles and responsibilities were not always clearly defined, documented or communicated,” Melvin writes in a summary of GAO investigators’ findings. “A number of states faced hurdles in communicating with stakeholders and receiving timely CMS guidance.”
In one table in the report, Melvin gives a description of all of the offices and groups responsible for state exchange IT project oversight. She notes, for example, that one well-known CMS division, the Center for Consumer Information and Insurance Oversight (CCIIO), has state office officers who are supposed to help the CCIIO executive director oversee state exchange construction and grant money use.
Some of the other offices that are, or should be, involved include the CMS Office of Acquisition and Grants Management, the CMS Marketplace Operations Board, the CMS Health Reform Operations Board, and the CMS Office of Communications, according to the table.