(Bloomberg) — Infrastructure for health insurance exchanges crafted by four Republican governors won conditional approval from federal government as states move toward full implementation of the Patient Protection and Affordable Care Act.

Idaho, New Mexico, Nevada and Utah are set to meet PPACA rules for marketplaces where residents can buy insurance, the Health and Human Services Department said in a statement last week. The agency also approved plans in Democratic-led California, Hawaii and Vermont, making a total 18 states plus the District of Columbia scheduled to run exchanges on Jan. 1, 2014.

“In all of these states there’s more work to be done to be ready for open enrollment in October, but we believe they’ve made significant progress,” says Gary Cohen, director of HHS’s Center for Consumer Information and Insurance Oversight.

States either have to let the U.S. run the markets or choose to provide services such as consumer assistance in a partnership with the federal government. States have until Feb. 15 to enter a partnership. Arkansas was approved last week to operate a State Partnership Exchange. HHS issued additional guidelines on how the joint exchanges will operate.

Enrollment in the exchanges must begin by Oct. 1 for plans that will take effect next year. The federal government plans to give states that run their own exchanges a share of about $2 billion to help get them started.

So far, 22 Republican governors have said they’ll refuse to participate, leaving it to the federal government to set up markets in those states.

The department says it is taking no action yet on an application from Mississippi, where the Republican insurance commissioner and governor are fighting over whether to go forward with an exchange.

Cohen says the department has no deadline for granting final approvals. States that opt out of running their own exchanges will have another opportunity to apply in November, he said. If approved, the government would run the exchange until state officials take over in 2015.

“One way or another there will be an exchange operating in every state by October 2013,” Cohen says.

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