State-Based Marketplaces

A seamless transition to a state-based marketplace

Many states are considering running their own health insurance marketplace. As a leading provider of eligibility and enrollment services across the nation, Maximus can help you make that successful transition.

Proven solutions to meet your needs

Since the enactment of the Affordable Care Act, many states are realizing the advantages of a state-based marketplace (SBM). We've implemented and operated the systems and processes for many SBMs, bringing best practices to drive better outcomes and ultimately reduce the number of the uninsured.

Read our latest insight: Five considerations for establishing a successful SBM
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We can help you achieve the benefits of an SBM

There are compelling reasons for operating your own SBM. Get the design flexibility to support state-specific policy, program, and fiscal goals. Extend your Open Enrollment Periods. Design a customer service experience that meets the needs of your residents, including integrated customer service with other state-administered health programs or state financial assistance. Tailor your outreach and education to consumers. Make program and fiscal decisions about your in-person assistor program and other marketplace features that are most important to your state.

Connect with our experts to learn more
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Our capabilities for establishing your state-based marketplace

  • Omnichannel Customer Service

    We put your consumers first. We help you modernize your customer service approach for a more accurate, timely, and efficient experience. In addition to superior customer contact centers, we provide consumers access to digitally-enabled customer service through interactive voice response, webchat, interactive website, and mobile document upload apps for faster access to benefits.

  • Integrated Eligibility and Enrollment

    We’re uniquely positioned to help your consumers transition from one type of coverage to another through a single point-of-entry model. We can help consumers get to the right place to avoid a gap in their coverage when moving between programs like Medicaid, the Children’s Health Insurance Program, and marketplace Qualified Health Plans.

  • Outreach and Education

    Our demonstrated outreach and education approach helps you reach your consumers through award-winning social media campaigns, member communications, expert translation services, and outbound call campaigns.

  • Assistor Training

    We expertly train our own staff and, at your request, can provide training to your state-selected navigators, assistors, and certified application counselors.

  • Operations Support

    We manage workflow and handle incoming mail, including sorting, scanning, and uploading documents.

  • Appeals

    We have a deep understanding of the fair hearing process and can assist with appeal processing. Our informal dispute resolution program has a proven track record of resolving consumer issues quickly, leading to increased customer satisfaction and allowing states to focus resources on fair hearings when requested by the consumer.

A trusted partner

We’re the country's leading consumer assistance services vendor for SBMs. More states have chosen us over other companies to provide high-quality consumer assistance support for their SBMs. In Maine, Maryland, New Jersey, New York, Vermont, and the District of Columbia, we’re providing end-to-end, full-service, omnichannel solutions that include customer service support, outreach, engagement strategies, and other consumer-focused services. Now, we’re ready to help you achieve your vision for your state-based marketplace.

Let’s talk about transitioning to an SBM
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