On June 28, 2019, Governor Phil Murphy signed legislation to establish a State-Based Health Exchange in New Jersey. The law is part of the state’s work to improve access to health coverage and care for New Jersey residents by building upon the progress made through the Affordable Care Act. New Jersey has already taken significant action – it established a reinsurance program, implemented a requirement to have coverage, and took over plan management of the exchange in New Jersey. As a result of the state’s work, rates in the individual market went down by 9.3 percent in 2019.

The Murphy Administration is continuing its work to advance the ACA and support additional efforts to stabilize and strengthen the market. As part of its efforts, the administration intends to operate a State-Based Exchange (SBE) for 2021 and, as part of its transition, to operate a State-Based Exchange on the Federal Platform (SBE-FP) for 2020. On August 1, 2019, the Department submitted to the Centers for Medicare and Medicaid Services its Blueprint to operate an SBE for Plan Year 2021 and an SBE-FP for Plan Year 2020.

The New Jersey Department of Banking and Insurance is transitioning to a State-Based Exchange on the Federal Platform (SBE-FP) for plan year 2020. This will allow the state to better transition to a State-Based Exchange (SBE) for plan year 2021, while providing additional outreach and enrollment assistance to New Jersey residents for the upcoming open enrollment period, beginning November 1, 2019.

Benefits of Transitioning to a State-Based Exchange on the Federal Platform (SBE-FP)

Under a State-Based Exchange on the Federal Platform (SBE-FP), consumers will continue to enroll in coverage through HealthCare.gov, the federal exchange platform which New Jersey has used since implementation of the Affordable Care Act. An SBE-FP model provides numerous benefits to the state including allowing the state access to federal data and to increase its investment in outreach and enrollment efforts.

Navigator Program and Certified Application Counselor Program

As per the requirements of the SBE-FP, the state will establish a state-funded and state-operated navigator program (the New Jersey State Navigator Program) for plan year 2020 operated by the New Jersey Department of Banking and Insurance. The department will also establish a Certified Application Counselors program for plan year 2020. Navigator organizations and Certified Application Counselor Designated Organizations (CDOs) will be required to obtain approval from the state, through the New Jersey Department of Banking and Insurance, to operate for the Open Enrollment Period beginning November 1, 2019 and for plan year 2020. CDOs will continue to oversee the activities of Certified Application Counselors and provide certification to CACs. The department will provide certification to individual Navigators. Individual Navigators and CACs must be certified by October 31, 2019. CDOs must apply by October 20, 2019 for designation by the state.

• State Certification and Training Requirements for Plan Year 2020
  
  
• Certified Application Counselor Designated Organizations (CDOs)
  
  
• New Jersey State Navigator Program