In a June 6 letter responding to the GAO concerns, Jim R. Esquea, assistant secretary for legislation for the Department of Health and Human Services, assured the auditors that "on Oct. 1, 2013, a health insurance marketplace will be open and functioning in every state."
CMS is supposed to operate "federally facilitated exchanges" in 34 states that have elected not to run state-based exchanges in 2014. Fifteen of those 34 states are expected to help CMS operate their FFEs in one capacity or another, but GAO says that exact role continues to evolve, even with the open enrollment period looming only four months from now. GAO noted that CMS approved states' exchange arrangements on the condition that the states actually do what they said they were going to do to make the exchanges operational. However, it's not clear how that process is going. If states don't meet their part of the deal, CMS said it would step in and carry out the necessary steps to make the exchanges operational.
"CMS is also depending on the states to implement specific FFE exchange functions, and CMS data show that many state activities remained to be completed and some were behind schedule," GAO said.
GAO says many other provisions that are the responsibility of CMS remain to be completed and some were behind schedule, especially functions related to "core exchange functional areas of eligibility and enrollment, plan management, and consumer assistance."