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Massachusetts health insurance exchange

MA will rebuild with hCentive

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The Massachusetts Health Connector is on track to deliver a much improved application and enrollment experience for consumers when 2015 enrollment begins Nov. 15. The Health Connector struggled with technological problems during 2014 open enrollment.

Massachusetts spent the spring and summer evaluating whether to fix its system and continue as a state-run exchange or transition to HealthCare.gov. After successful testing a new vendor’s system, Massachusetts announced in August it will remain a state-run exchange.

Preparing for open enrollment

With its technology strategy decided and implementation and further testing underway, the Health Connector team is ramping up customer service support and its marketing and outreach plan.

The Health Connector has hired 680 customer service representatives, twice as many as last year, and is providing six weeks of training to help consumers during 2015 open enrollment.

The Health Connector needs to reach three distinct groups: the “transition” population that was placed in temporary coverage for 2014, the uninsured population, and the currently insured who need to re-enroll for 2015 or who are seeking coverage through the Health Connector for the first time.

The Health Connector outreach plan includes a mix of direct member contact (such as mailings and phone calls), enrollment assistance (such as enrollment fairs and navigators), and media and general awareness strategies (such as radio, TV, and town hall events). The Health Connector plans to apologize for the hassles consumers experienced last year, while motivating them to take action to get the coverage they need in 2015. The Health Connector will work with Health Care for All — a consumer advocacy organization — to attend more than 100 health fairs, knock on 200,000 doors, produce materials in seven languages to reach more than 250,000 consumers, and place 2 million outbound calls — most of them automated “robo” calls.

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 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.

Everyone must re-enroll

Given the problems with its old technology, Massachusetts Health Connector cannot process re-enrollments automatically. People who are currently enrolled in QHPS, the extended Commonwealth Care program, the Medical Security Program (MSP), and temporary MassHealth coverage must re-enroll for 2015.

The Health Connector is seeking extensions to spread out the re-enrollment process and protect its website from being overloaded. As described above, the Health Connector has extensive outreach planned to reach those consumers who need to re-enroll as well as about 50,000 people who are still uninsured and could potentially enroll for the first time.

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 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.