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Massachusetts health insurance exchange

Deadlines vary on MA Health Connector

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The Health Connector struggled with technological problems during 2014 open enrollment, and officials spent the spring and summer evaluating whether to fix its system or transition to HealthCare.gov. After successful testing of a new vendor’s system, Massachusetts announced in August it would remain a state-run exchange.

The second open enrollment period started Nov. 15 and continues through Feb. 15, 2015. The re-launched Health Connector appears to be working well for most users. More than 57,000 people visited the site during the first weekend of open enrollment.

As of Dec. 4, 58,227 people have qualified to purchase QHPs through Health Connector. Nearly 29,500 of those qualified have selected a health plan. An additional  29,439 people have enrolled in MassHealth coverage.

Most need to re-enroll

Given the problems with its old technology, Massachusetts Health Connector cannot process re-enrollments automatically. People who were enrolled in qualified health plans, temporary MassHealth coverage, and other coverage through Health Connector for 2014 must re-enroll for 2015. However, deadlines vary for different groups:

  • Individuals who were enrolled in a QHP need to complete an application, pick a health plan, and make their first premium payment by Dec. 23, 2014.
  • Individuals who were enrolled in Commonwealth Care/Medical Security Program (MSP) need to complete an application, pick a health plan, and make their first premium payment by Jan. 23, 2015.
  • Individuals who were temporarily enrolled in MassHealth coverage and received a purple letter need to fill out an application, pick a plan and make their first premium payment by Dec. 23, 2014.
  • Individuals who were temporarily enrolled in MassHealth coverage and received a blue letter need to fill out an application, pick a plan and make their first premium payment by Jan. 23, 2015.
  • Individuals who were temporarily enrolled in MassHealth coverage and received a green letter need to fill out an application, pick a plan and make their first premium payment by Feb. 23, 2015.

Individuals who qualify for MassHealth on an ongoing basis (not those temporarily assigned to the program as a workaround to system problems) should follow the instructions they received from MassHealth.

Those who are applying for coverage for the first time need  to submit an application to see if they qualify for a qualified health plan (QHP) or another type of coverage (MassHealth, ConnectorCare, etc.). Those who qualify for a QHP need pick a health plan and make their first premium payment by Dec. 23, 2014. Those who qualify for one of the medical assistance programs will receive further enrollment instructions.

The path to a better system

Massachusetts officials pursued a “dual track” solution to make the Health Connector work better for the 2015 open enrollment period. One track evaluated replacing existing Health Connector software with hCentive, an off-the-shelf software solution that was successfully used by the Colorado, Kentucky, and New York exchanges. The second track considered was transitioning to the federal exchange, HealthCare.gov, for enrollment.

In early July, hCentive successfully demonstrated that it could connect to the federal data hub to verify applicants’ identifies and income levels. After additional testing in August, Massachusetts and CMS determined continuing as a state-run exchange using the hCentive platform was the right approach for the state.

The hCentive system has been customized for the Massachusetts insurance marketplace. It supports State Wrap, which provides additional state-sponsored premium assistance, as well as a “single door” enrollment for either private health insurance or MassHealth, the state’s Medicaid program. The hCentive system also includes functionality to better handle transactions between insurance companies and consumers and “back office” functions for insurers.

State officials put the cost of rebuilding Health Connector at $254 million, with the state paying $30 million and the federal government paying the balance. In addition, the state has paid $259 million in medical claims for people who were placed temporarily placed on MassHealth.

Health Connector 2014 enrollment counts

The Health Connector reported that it enrolled 308,000 people into coverage in 2014. Given that the Health Connector was set up several years before the ACA was passed, many of the 308,000 were already in one of several state-sponsored programs. The final HHS 2014 enrollment report put Massachusetts’ enrollment in qualified health plans (QHPs) at 31,695.

Of the 308,000 enrollments reported by the Health Connector, about 271,000 were for subsidized coverage and about 37,000 were for unsubsidized coverage. The subsidized figure includes more than 200,000 people who were given temporary coverage through MassHealth (Medicaid) while technological problems were addressed. The subsidized figure also includes residents who were shifting from existing state-sponsored programs to new or different programs that are aligned with ACA’s eligibility standards.

History of Massachusetts Health Connector

Massachusetts enacted comprehensive health reform in 2006 that created the Massachusetts Health Connector. Massachusetts’ reforms served as the model for the 2010 Affordable Care Act (ACA).

While the ACA health insurance marketplaces were modeled on the Massachusetts exchange, the technical upgrades that were needed to make Health Connector ACA-compliant were not implemented smoothly or on time.

The Health Connector performed very poorly during the first ACA open enrollment period. Health Connector hired a consultant, MITRE Corporation, to assess its website problems. MITRE determined that CGI — the lead IT vendor — lacked 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, state officials deemed it too disruptive to cut ties with the vendor during 2014 open enrollment. In January, Massachusetts brought on Optum, a subsidiary of United HealthGroup, to work through some of the immediate problems with the Health Connector. When 2014 open enrollment ended, Health Connector officials moved to terminate the CGI contract.

Massachusetts health insurance exchange links

Massachusetts Health Connector
877-MA-ENROLL (877-623-6765)

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.