Maryland and five other states received conditional federal approval Monday to operate a state exchange, or marketplace where individuals can buy insurance under health care reform.
The approval by the Centers for Medicare & Medicaid Services means that Maryland is on track under federal guidelines to operate an exchange during open enrollment next October. Most aspects of health reform will be implemented in 2014.
Colorado, Connecticut, Massachusetts, Oregon and Washington also were approved. All the states will be eligible for federal funding that will pay for most of the costs of setting up and running the exchanges. Maryland already has received $157 million in federal grants for its exchange.
Maryland was one of the early supporters of health care reform and began building an exchange even as the law's constitutionality was challenged in the courts and its future faced uncertainty because of last month's election.
Now health reform is moving forward with the re-election of President Barack Obama and the Supreme Court's decision in June that the law is constitutional.
States have until Friday to apply to operate a state exchange or choose one run by the federal government. At least a dozen states have said they would not run their own exchanges. In addition to Maryland, 14 states and Washington, D.C., have taken major steps toward establishing exchanges.
Lt. Gov. Anthony G. Brown called the approval a milestone and said in a statement that the state "will continue to maximize the Affordable Care Act in order to make Maryland the healthiest state the nation." Brown has led the state's health reform efforts.
The law requires that everyone carry insurance through an employer, a government-sponsored plan such as Medicare or statewide exchanges. Individuals and companies would have to pay a penalty to opt out. The idea is to spread the cost of health care to everyone, while working on ways to deliver it more efficiently.
State officials estimate that one-third of Maryland's 750,000 uninsured residents will gain coverage under reform in its first year. Those living on less than 133 percent of the federally established poverty level — about $31,000 for a family of four — also will gain coverage through an expansion of Medicaid.