SBE Budget Template 2024

State-based Exchange Budget
FY 2023 - 2024
CCIIO/SMIPG
A.	General Information	Details	Notes (if needed)
	State:	Select Your State
	State Budget Year (indicate if Calendar or Fiscal):	Fiscal
	e.g.: Oct 1- Sep 30 If State Budget Year is Fiscal, indicate the date range:
	Note: Total Full Time Equivalents engaged in the Individual Marketplace activities. Total Marketplace FTE
	Does the state require issuers to pay a carrier assessment (user fee)? If yes, is it a broad or market wide assessment?	Yes
	Carrier Assessment (User fees) This is carrier assessment for the individual Marketplace and should not include outside of Marketplace values. If a flat dollar amount, please estimate in the notes how it might translate to a percentage of premiums
	General Notes/Comments (if needed):
B.	Marketplace Effectuated Enrollment	2023 Actual	2024 Projected	Notes (if needed)
	Total QHP Enrollment for Plan Year
	Note: The count of accumulated members over the 12 month period for Individual Marketplace enrollment. Member Months	0	0
C.	Revenue		2023 Actual $	2024 Projected $	Notes (if needed/as requested)
	Total Marketplace Carrier Assessment Collected	Indicate sources in the Notes column.
	Revenue or Reimbursement from Medicaid/CHIP	Include Federal and state together.
	Other State Revenue Sources (list sources below)
	Total $ Revenue		$0	$0
D.	Marketplace Expenditures (total revenue and expenditures should balance out)	Definition/Details	2023 Actual $	2024 Projected $	Notes (if needed/as requested)
	General Totals		$0	$0
	Personnel and Fringe	Officer and director salaries, temporary help, etc.
	Indirect Costs	Travel, supplies, etc.
	Facility and Other Non-IT Administrative	Rent, utilities, repairs, printing, etc.
	Other (list items in Notes column)	Vendor costs should be built into other lines items.
	External Marketing & Outreach Totals		$0	$0
	Navigators/IPAs	Grants or fees.
	Direct Marketing & Outreach to Consumers	Consumer facing education, training, outreach activities, and materials.
	Education & Outreach to Agents/Brokers and Issuers	Agent/broker and issuer facing education, training, outreach activities, and materials .
	Paid Media/Advertising	Paid media, TV, Radio, etc.
	Non-Paid Media/Advertising	e.g.: Development of outreach materials, graphic design, marketing content on websites, campaigns Efforts dedicated to engaging consumers, alliances, etc., social media.
	Other (list items in Notes column)	Training Support Materials, Communications, Research, Website, Event Management
	Note: Percent should be entered as number between 1 and 100. % of Total External Marketing & Outreach Allocated to Contractors	Contractor allocation.
	Note: If call center totals are $0, then please provide a note explaining why. Call Center Totals		$0	$0
	Maintenance and Operations	Note: Include fixed and variable cost in the total. Labor, back office labor, technology, operations, etc.
	DDI	Efforts associated with development and enhancements.
	Other (list items in Notes column)	Other.
	Note: Percent should be entered as a number between 1 and 100. % of Total Call Center Allocated to Contractors	Contractor allocation.
	Note: If IT Platform totals are $0, then please provide a note explaining why. IT Platform Totals		$0	$0
	Maintenance and Operations	Note: Include fixed and variable cost in the total. Labor, back office labor, technology, operations, etc.
	DDI	Efforts associated with development and enhancements.
	Other (list items in Notes column)	Other.
	Note: Percent should be entered as number between 1 and 100. % of Total IT Platform Efforts Allocated to Contractors	Contractor allocation.
	Total $ Expenditures		$0	$0
E.	Net Gain/(Loss)		2023 Actual	2024 Projected	Notes (if needed)
	Legislative Authority to have a reserve (Select Yes/No from drop-down choices)		Yes	Yes
	Total Reserve
	Number of Months of Reserve	Number of Months currently available for reserve.
	Number of Months of Allowable Reserve	Number of Months allowed to have reserve available for.
	Total $ Net Gain/(Loss)	Indicate in Notes if reserves/other funding source covers any loss.	$0	$0
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