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The National Governors Association is asking the U.S. Department of Health and Human Services to let states retain control over traditional functions such as determining Medicaid eligibility when health information exchanges go into effect next year. They also asked for federal help in pre-certifying and identifying health IT products and services needed to operate a health insurance exchange.

In their Nov. 2 letter to HHS Secretary Kathleen Sebelius, the governors note that while the proposed rules on establishing HIEs force states to give up operations such as determining eligibility for Medicaid, they are required to take on other functions traditionally handled by the federal government.

They also expressed concern that states would not be eligible for federal funding to establish new state exchange functions after 2012.

"States are concerned that this construction would lock states in an all-or-nothing approach where the state's role in operating the exchange would be limited with little opportunity to gain additional operational authority if a state so chooses at a later date," the letter says. " ...(M)any states are undecided on implementation strategies because of various uncertainties, including the lack of final rules and regulations."

The governors propose that states be allowed to ask the federal government to continue handling functions such as eligibility and appeals for federal tax credits and subsidies; helping the Treasury Department pay insurers tax credits on premiums in advance; enforcing individual responsibility provisions; and reporting user and employer data to Treasury.

The letter applies only to states that plan to participate in state-federal partnership health insurance exchange (HIE) models.