Maryland Health Connection, the state-run marketplace, has experienced numerous challenges including technical problems, legal disputes, the executive director’s resignation, and more. It has been one of the more troubled exchanges in 2014, but things are looking up as 2015 open enrollment approaches.
The exchange has purchased technology from the successful Access Health CT exchange to replace its own beleaguered system. In addition, they’re planning a staggered start to open enrollment in an effort to ward off volume-related troubles.
Improvements for 2015 open enrollment
Open enrollment begins on Nov. 15, but Maryland is planning a staggered start in order to limit traffic in the first several days of open enrollment. They will have plans available for consumers to browse anonymously starting on Nov. 9. This is a major improvement over last year, when consumers were unable to browse plans until after they had created an account with the exchange.
On Nov. 15, residents will be able to sign up at about 25 enrollment fairs across the state. On Nov. 16, the exchange’s call center will begin enrolling people, and on Nov. 17, brokers and navigators will be able to start submitting applications. On Nov. 18, the enrollment website will be available for health and social service caseworkers who are assisting people with their applications. Beginning on Nov. 19, the site will be fully available for anyone in Maryland to use.
New technology for Maryland Health Connection
Maryland has also purchased technology from Access Health CT — a proven, successful system — and will be operating on the new platform when open enrollment begins in November. The technology change coupled with the staggered start should make for a much better kickoff to open enrollment this year.
People who enrolled in private plans through the Maryland Health Connection in 2014 need to re-enroll during the 2015 open enrollment period. The transition to the new software means that subsidy eligibility will need to be redetermined. People who don’t re-enroll will be able to keep their existing health insurance policy, but not their subsidy. Since most enrollees received a subsidy in 2014, the exchange is encouraging everyone to re-submit their financial information in order to determine subsidy eligibility for 2015.
The Maryland Insurance Administration released approved 2015 premiums in late August. Three of the six carriers offering policies in the individual market in 2014 will have lower premiums next year, while the other three will have rate hikes. The increases for those three companies are lower than what they requested, thanks to careful review by the Maryland Insurance Administration.
- CareFirst (average premium increase of 9.8 percent)
- Kaiser Permanente (average premium decrease of 6.7 percent)
- Evergreen Health Cooperative (average premium decrease of 6.7 percent)
- Cigna (new to the exchange for 2015)
- United Healthcare (new to the exchange for 2015)
2014 enrollment recap
Despite all of the problems, Maryland exceeded its enrollment goal of 260,000. As of Aug. 23, the Maryland exchange had enrolled nearly 434,000 people: 78,666 in private health plans, and another 355,281 in Medicaid or the Children’s Health Insurance Program (CHIP).
The vast majority of those enrolling in QHPs selected plans offered by CareFirst BlueCross BlueShield. CareFirst captured nearly 94 percent of enrollees during the first open enrollment period, followed distantly by Kasier with about 5 percent, Evergreen Health Cooperative with 0.7 percent, and All Savers (part of United Healthcare) with 0.4 percent.
Difficulties in 2014
Severe technical problems plagued the Maryland Health Connection website in 2014. Some consumers who were unable to sign up for private insurance were temporarily enrolled in the state’s high-risk insurance program, at the state’s expense. Problems with determining who qualifies for Medicaid means the state may make about $20 million in unnecessary payments over two years. Maryland fired its prime contractor, Noridian Healthcare Solutions, and hired Deloitte Consulting to adapt Connecticut’s successful technology for use by Maryland. Consultants put the cost of rebuilding the Maryland Health Connection website at up to $60 million.
Maryland Health Connection has been criticized for its lack of transparency. News outlets have informally complained about inadequate disclosure of website problems, and the Kent County News filed a formal complaint with the state’s Open Meetings Compliance Board. Industry experts, state and federal legislators, and the state comptroller have all questioned the mostly closed-door meetings during which exchange officials decided to rebuild the state’s website rather than transition to the federal site.
In addition, the Maryland Health Benefit exchange, which oversees the marketplace, has repeatedly delayed the launch of the Small Business Health Options Program (SHOP). Work on the SHOP website was put on hold in February, and the launch date pushed back until Jan. 1, 2015. As of April, small businesses can purchase policies and receive tax credits by working directly with insurers or through brokers or third-party administrators (TPAs). Thirteen insurers are selling small-business plans.
Maryland Health Connection History
Maryland was an early adopter of the health insurance marketplace envisioned by the Affordable Care Act (ACA). While many other states waited to see the outcome of the Supreme Court challenge to the ACA, Maryland moved ahead. The Maryland Health Benefit Exchange (MHBE) was signed into law in April 2011, with additional legislation passed in May 2012. The MHBE was later rebranded as the Maryland Health Connection. In December 2012, the Maryland Health Connection was among the first six state-based exchanges to be approved by the federal government.
Maryland Health Connection is overseen by a nine-member board. On June 25, Carolyn Quattrocki was named to a one-year term as executive director of the board. She began serving in that role on an interim basis in December 2013 following the resignation of Rebecca Pearce.
Maryland Health Connection functions as a clearinghouse, meaning any QHP can sell policies on the exchange. Any health plan with significant market share in the state is required to participate in the marketplace. After two years of operation, the exchange has the option to adopt an active purchaser model. Health plans are limited to selling four benefit packages per metal level (platinum, gold, silver, and bronze).
Maryland health insurance exchange links
Maryland Health Connection
Maryland Health Benefit Exchange (MHBE)
Information about exchange planning and development
State Exchange Profile: Maryland
The Henry J. Kaiser Family Foundation overview of Maryland’s progress toward creating a state health insurance exchange.
Health Education and Advocacy Unit, Office of the Attorney General
Serves residents and other consumers who receive health care from a Maryland health care provider or health insurance provider.