Health and Human Services (HHS) Secretary Kathleen Sebelius recently announced Iowa, Michigan, New Hampshire, and West Virginia as conditionally approved to operate State Partnership Marketplaces, which will be ready for open enrollment in October 2013. The HHS Secretary has the authority to declare which states meet the criteria to establish either a state or partnership exchange. Conditional approval means that states are on track to meet all Exchange deadlines. To date, 24 states and the District of Columbia have been conditionally approved to partially or fully run their health insurance marketplaces. HHS will continue to provide all states with the flexibility, resources, and time needed to support the establishment of the new health insurance marketplace.