For States that do not seek to operate a State-based Exchange or a Partnership with the Federally- facilitated Exchange, HHS will establish and operate a Federally-facilitated Exchange. In such instances, a State may elect to run reinsurance and may elect to coordinate with CMCS on decisions and protocols for either an eligibility assessment or eligibility determination model in the Federally- facilitated Exchange. HHS will work in collaboration with States in all areas, particularly in areas where a State can leverage existing processes, to ensure the best, most effective experience for its residents. Regardless of the model, HHS intends to work in.
