Most States Shun Fed HIX Partnerships, But Seek Accommodations

Ohio sent similar overtures to HHS, and Pearson says it is uncertain how those states' actions will affect their exchanges.

"Until we get more guidance from HHS on whether this is permissible or what the legal authority is, I'm not sure we're going to have a clear understanding of it," says Pearson.

It's unlikely either state will forego grant money. HHS has made it clear that states who chose a federally run model will not be exempt from grants.

Another state is also attempting to set its own ground rules on a federally run exchange. South Dakota legislators are considering a bill that would require a person buying health insurance on the exchange to use an agent.

In general, states have broad authority over brokers and agents interacting with the exchanges, but South Dakota's actions, if passed, could potentially drive up the cost and complexity since the exchange is meant to be mostly an online experience for the user.

"The idea that South Dakota would mandate the use of a broker, would be quite novel, but that would be in their jurisdiction," says Pearson.