Mississippi was one of a few states to operate a hybrid exchange model, but the state's own small business exchange, One Mississippi, stopped accepting enrollees at the end of 2017 and transitioned to HealthCare.gov. The federal government continues to run the state's individual insurance exchange. Competition on both exchanges is limited, as the state's largest insurer, Blue Cross and Blue Shield of Mississippi, opted not to participate in either exchange. For 2020, however, residents in 19 counties will have an additional option as Molina joins the exchange. Meanwhile, the state is still a Medicaid expansion holdout.