State Responsibilities States ensure that all eligible individuals enroll in a regional or corporate alliance and have access to a health plan that delivers the guaranteed comprehensive benefit. Each state must implement plans approved by the National Health Board by January 1, 1997. States may begin to implement the new system as early as January 1, 1995. Implementation involves adopting federal standards and establish health alliances. Within the broad federal guidelines, states exercise flexibility in the design and governance of regional health alliances.
States have the option to implement a single-payer system.
States certify health plans, much as they license health providers and insurance companies today. They determine mechanisms for evaluating the quality of health plans, their financial stability and capacity to deliver the guaranteed benefits, as well as compliance with prohibitions against discrimination based on race, ethnicity, gender, income and health status. Only certified plans may offer health coverage through alliances. In the case of areas where no health plan forms, the state must assure that at least one health plan is available to cover every eligible individual. Each state creates one or more regional alliances that organize a menu of health plans, negotiate premiums and enroll individuals in plans.