State health care exchange plans still must be in place for approval by Jan. 1, 2013, but the U.S. Department of Health and Human Services will help support the process operationally as states move toward exchange certification, according to Amanda Cowley, acting director for state health exchanges, for HHS's Centers for Medicare and Medicaid Services.

"States have made some progress," Cowley told participants at America's Health Care Plans state issues conference in Washington Thursday. "States are a lot smarter now than they were a year ago. Over 80% of states have done background research," she said. HHS is beginning to see states act but the extent varies widely, she said. But HHS is "seeing a movement and very pleased with that."

With that, HHS is trying to "intensify" its response to the states, and has been holding listening sessions and "imagining a highly collaborative" process.