The OIG has issued an “Early Alert” warning regarding the use of federal funding by state-based marketplaces under the Affordable Care Act (ACA). The OIG notes that the ACA clearly prohibits marketplaces from using grant funds to support ongoing operations after January 1, 2015. The OIG expresses its “concerns that, without more detailed guidance from CMS, state-based marketplaces (SBMs) might have used, and might continue to use, establishment grant funds for operating expenses after January 1, 2015, contrary to law.” The OIG recommends that CMS consider establishing clear guidance on what constitutes (1) operational costs and (2) design, development, and implementation costs to minimize the marketplaces' improper use of establishment grant funding for operational expenses after January 1, 2015. In developing this guidance, the OIG encourages CMS to review SBM plans for using establishment grant funds to ensure that the guidance addresses real-world examples (e.g., call centers, in-person assisters, bank fees, and printing and postage expenses). Finally, the OIG encourages CMS to monitor SBMs' use or potential use of establishment grant funds for operational costs and take appropriate action.