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Massachusetts health insurance exchange

MA exchange plagued by problems; HealthCare.gov could be answer

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The Obamacare open enrollment period for 2014 has ended in Massachusetts. People who get married or divorced, change jobs, have a child or experience another qualifying event may be eligible for a special enrollment period. Enrollment for MassHealth (a state program that combines Medicaid and the Children’s Health Insurance Program, or CHIP) continues throughout the year. Individuals who don’t have health insurance that provides “minimum essential coverage” may have to pay a penalty: $95 or one percent of income, whichever is greater.

Open enrollment for 2015 coverage through the marketplace begins Nov. 15.

While the health insurance marketplaces created by 2010 Affordable Care Act (ACA) were modeled on the Massachusetts exchange, the Health Connector performed very poorly during the first ACA open enrollment period. Technical upgrades that were needed to make Health Connector ACA-compliant were not implemented smoothly or on time.

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 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 extended the deadline to Dec. 31.

As of May 1, about 31,700 people had enrolled in private health plans. About 126,000 people who applied for subsidized coverage have been temporarily enrolled in MassHealth plans while systems experts work to repair the Health Connector. An additional 96,000 people remain on state-sponsored programs that pre-date the Affordable Care Act.

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 Connector. The Optum contract is valued at nearly $10 million. With open enrollment now over, Health Connector officials moved to terminate the CGI contract. In an agreement announced in late June, the state will pay CGI about $37 million of an $89 million contract for work completed. The state will pay an additional $15 million for ongoing operation of the system as it is transitioned to Optum. Massachusetts reserved the right to sue CGI, and the state attorney general is exploring the possibility of legal action that would allow the state to recoup up to $12 million.

Massachusetts officials are pursuing a “dual track” solution to make the Health Connector work better for the next open enrollment period.  One track will evaluate replacing the existing Connector software with hCentive, an off-the-shelf software solution that was successfully used by the Colorado and Kentucky exchanges. hCentive would be customized for the Massachusetts insurance marketplace and support a “single door” enrollment for either private health insurance or MassHealth. The second track is to use the federal exchange, HealthCare.gov, for enrollment. This option would also require customization to accommodate the state’s existing health insurance programs for low-income residents.

In early July, hCentive successfully demonstrated that it can connect to the federal data hub to verify applicants’ identifies and income levels. Additional testing is slated for early August. If the hCentive system passes that test, Massachusetts will abandon the HealthCare.gov track according to Maydad Cohen, who is now overseeing the Connector as a special advisor to Gov. Deval Patrick. If the hCentive system does not pass the August test, Massachusetts will use HealthCare.gov for 2015 open enrollment and continue to pursue a state-run system for 2016.

State insurers are not pleased with the dual track as it forces them to forces them to put resources into both options — saying that if they wait for the state’s decision they risk not being ready for open enrollment.

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.