By Carla Anderson
February 25, 2014
While the health insurance marketplaces created by 2010 Affordable Care Act (ACA) are modeled on the Massachusetts exchange, the Health Connector has performed very poorly since the current enrollment period opened on Oct. 1. Technical upgrades that were needed to make Health Connector ACA-compliant were not implemented smoothly or on time. Consumers have had difficulty creating accounts and experienced broken links, error messages, and “frozen” screens. Even worse, software on the Health Connector is not able to determine which type of subsidies consumers are eligible for. That issue has forced Health Connector to process many applications manually.
Health Connector hired a consultant, MITRE Corporation, to assess its website problems. MITRE determined that CGI, the lead IT vendor, lacked the necessary expertise, managed the project poorly, lost data, and failed to adequately test the revamped website prior to its launch. MITRE also said the roles and decision-making authority of the three state entities involved in the project (Massachusetts Health Connector, MassHealth, and the University of Massachusetts Medical School) were unclear.
Despite the issues with CGI, Gov. Deval Patrick said it would be too disruptive to cut all ties with CGI. The state is withholding payments until it is satisfied with CGI’s work. So far, the state has paid CSI $15 million of a $68 million contract that runs through September. Massachusetts is bringing on Optum, a subsidiary of United HealthGroup, to work with CGI. The Optum contract is valued at nearly $10 million. Gov. Patrick appointed Sarah Iselin, chief strategy officer at Blue Cross Blue Shield of Massachusetts, to lead the fixes to the Health Connector and oversee the work of CGI and Optum.
The technical issues dogging the Health Connector have severely hampered enrollment. Through Feb. 6, just 8,444 people had enrolled in private health plans. Previous state coverage was extended for about 124,000 people, and 30,000 new applicants were granted temporary state coverage. Iselin announced Feb. 21 that the Health Connector processed 22,000 online applications in the previous week, adding about 15,000 people to temporary coverage and determining that about 7,000 applications were duplicates. In addition to the ongoing processing of online applications, the Connector also needs to deal with a backlog of 50,000 paper applications. As of Feb. 21, about 28,000 paper applications have been screened. Of those, 19,000 were either duplicates or for people who already have covered. The applications for the remaining 9,000 are getting priority attention.
To fall in line with the ACA’s eligibility standards, Massachusetts had to rely on its balky system to manage not only new applicants, but also populations that were already enrolled in state-sponsored programs. The two main programs affected were Commonwealth Care (for uninsured low and moderate-income individuals) and Commonwealth Choice (for uninsured adults who make too much to qualify for Commonwealth Care). Those previously enrolled in Commonwealth Care moved to either MassHealth (a combined program for Medicaid and the Children’s State Health Insurance Program, or CHIP) or became eligible to shop for a subsidized plan on Health Connector. Those enrolled in Commonwealth Choice were to select a new plan by March 31; however, the federal government has extended the deadline to June 30.
Ten health insurers are offering 114 options on the Health Connector for 2014:
Massachusetts Health Connector
State Exchange Profile: Massachusetts
The Henry J. Kaiser Family Foundation overview of Massachusetts’ progress toward creating a state health insurance exchange.
Health Care for All – Massachusetts Consumer Assistance Program
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.(800) 272-4232
Office of Patient Protection, Department of Public Health
800-436-7757 (toll-free nationwide)
Serves residents and other consumers who receive health coverage from a Massachusetts carrier, insurer, or HMO.
Let your Massachusetts governor and legislators know how you feel about the state’s proposed health insurance exchange.Massachusetts Governor Deval Patrick