While there is much work to be done implementing the many facets of the health reform, creating the exchange marketplace(s) is one of the tasks that receives much of the attention. Not only is it a new concept to most states but, along with the expansion of Medicaid, it is the mechanism for insuring the 32 million Americans who are expected to gain coverage.

People tend to look to Massachusetts for lessons learned because the exchange concept in national reform is based on that state’s health reform model. In fact, early this year the State Coverage Initiatives (SCI) hosted a meeting of state officials in Boston to provide the nuts and bolts of how the Massachusetts exchange known as the Health Connector works. This two-day meeting drew more than 100 participants from 42 states, including representatives from state insurance departments, Governor’s offices, and the state department responsible for health programs. The SCI program, funded by the Robert Wood Johnson Foundation and administered by AcademyHealth, provides technical assistance to state leaders to help them move health care reform forward at the state level.

It’s important to note that other states beyond Massachusetts have made advances in health reform that can inform our efforts moving forward. SCI documented a number of the important issues in its report,”Implementing State Health Reform: Lessons Learned for Policymakers,” on the experience of five states: Massachusetts, New Mexico, Tennessee, Vermont and Wisconsin.

The report and its companion webinar focus on key questions and takeaways in a number of areas including enrollment and eligibility, marketing and outreach, staffing and coordination, and reporting and evaluation. It asks critical questions like:

• “Are current state information systems equipped to perform the necessary eligibility and enrollment functions for the health insurance expansion?”

• “To what extent can the state’s current CHIP and Medicaid outreach activities be modified to include outreach and marketing for the health insurance expansion?”

Some states are already moving beyond forming a key group of state officials charged with beginning the planning process. Wisconsin, one of the early state implementers of health reform, has recently issued a request for proposals (RFP) to add exchange functionality to its current eligibility system. Connecticut and the District of Columbia are early adopters of the new option to cover adults (both parents and adults without dependents) now without waiting for health reform.

And speaking of waiting…let’s not forget that with 5 million uninsured children already eligible for Medicaid or CHIP, kids don’t also have to wait for health reform.