Good news! The ACA requires Health Insurance Marketplace plans to contract with some (not all) Essential Community Providers (ECPs). In Federally-facilitated and Partnership Marketplaces, the following providers have been identified as ECPs: Federally Qualified Health Centers (FQHC) and FQHC “Look-Alikes”, Title X Family Planning agencies, Ryan White HIV/AIDS providers, Indian Providers and safety-net hospitals (hospitals that receive Disproportionate Share Hospital funding). Other ECP providers are STD Clinics, TB Clinics, Hemophilia Treatment Centers, Black Lung Clinics, and other entities that serve predominantly low-income, medically underserved individuals. More information is available from the Center for Consumer Information and Insurance Oversight (CCIIO). If you are not on the list, the issuer with whom you contract can add you.
In State-run Marketplaces, ECP requirements are specific to each state but providers that are eligible to participate in the 340B program applies. Check with your State’s Marketplace website to learn more.