State Slashes Health Care Enrollment Goals

February 27, 2014
BY Marc Shapiro
Maryland, which also fired an IT vendor, makes big changes as the March 31 deadline to enroll in the health exchange approaches
A screenshot of Maryland's online health care exchange website.

A screenshot of Maryland’s online health care exchange website.

With little more than a month until a March 31 deadline, Maryland health exchange officials revised insurance enrollment goals and terminated their contract with the company that built the state’s health exchange.

Noridian Healthcare Solutions, the North Dakota company behind the state online exchange that crashed when it launched Oct. 1, will no longer operate the site. The nine-member board governing the voted to terminate Maryland’s contract with Noridian on Sunday night.

In the interim, the exchange will be taken over by Optum/QSSI, the Columbia-based firm that was hired by the federal government in October to fix healthcare.gov.

The board also slashed Maryland’s private insurance enrollment goal by more than half, from 150,000 to 70,000. The move was reportedly attributed to an error found in data that a nonpartisan analyst group used for Maryland’s enrollment projections. The state still appears unlikely to hit its goal by March 31, with only 33,251 individuals enrolled in private plans through Feb. 15, according to Maryland Health Connection, the state’s online insurance marketplace.

The changes come two weeks after a bipartisan “oversight” committee of lawmakers met for the first time to probe Maryland’s troubled implementation of the federal Affordable Care Act.

In a project that has been marred by skepticism and scrutiny, those watching health care even have doubts about what the oversight committee will accomplish.

“If the oversight committee could be neutral people that really care about the technical aspects, then that’s really good,” said Larry Burgee, associate professor and chair of Stevenson University’s Department of Information Systems. “If it’s loaded with politicians from either side of the fence, there’s going to be problems. It’s too political on both sides.”

Even the change in vendors was met with skepticism. Tracey Paliath, director of economic services at Jewish Community Services, said changing a vendor on a big government project is never an easy process.

“If the problem was with the vendor, then absolutely move it and cut your losses now,” said the former assistant director of the Baltimore City Department of Social Services. “But if there is a problem with the communication … switching the vendor may or may not fix it.”

As far as lowering the enrollment goal goes, it remains to be seen if Maryland can more than double its enrollment numbers in little more than a month. How well the exchange is working depends on who’s doing the talking.

Sheila C. Bennett, an exchange navigator who works in the Randallstown area, said the glitches in Maryland’s health care website have diminished significantly since its launch.

“It’s tremendously better than it was in the beginning,” she said.

Bennett walks people through the enrollment process and answers any questions they may have. She said it takes people an average of one hour to sign up for insurance with her help, depending on the size of the family.

Steve Land, a support services coordinator at Jewish Community Services, said it took him and one client five-and-a-half hours over the course of three separate sessions to enroll in health care. The client was on disability but had an income too high for Maryland’s Primary Adult Care program. PAC participants are being rolled into Medicaid, which has expanded its availability.

“When they wrote this Affordable Care Act, if there was a client tailor-made for it, this client was,” said Land, who would not reveal the gender of the client for privacy reasons.

The two of them experienced delays with Maryland’s website, which wouldn’t move to the next page, locked up and quit. After finally getting through, the pair experienced issues with the start date of the Medicaid plan and records of the application being submitted.

“For a client that really deserved and really would have benefited from this, this would have been the person,” said Land. “It was discouraging.”

The client wound up going to the Medicaid office in Baltimore and getting the plan figured out.

Paliath worked with another client who applied for insurance in November. He was supposed to have a subsidy through CareFirst, according to the exchange, but CareFirst didn’t see that subsidy in its paperwork. After reaching out to a “high-level contact,” the client, a small business owner, was set to get his subsidy in February but had to pay the full premium in January.

For the Evergreen Health Co-Op, a new nonprofit health insurance company, the woes of the exchange have hit hard, especially since the co-op doesn’t carry the name recognition of the bigger insurance companies on Maryland’s exchange.

“We depended on the vast majority of our enrollees to come off the individual exchange, which crashed in Maryland,” said Dr. Peter Beilenson, the co-op’s founder, president and CEO. “We’ve had to take care of ourselves, and since we’re not able to sell on the individual exchange, we’re now starting to sell to small business.”

About 500 people have enrolled in plans with Evergreen, he said.

Beilenson’s assessment is that the online exchange has been fixed “modestly,” and he thinks Maryland might switch over to the federal exchange site between March 31 and the next open enrollment period, which is proposed to start in November.

As far as Maryland’s decreased goals are concerned, some think enrollment will increase in future years, as penalties for not having insurance increase. This year, penalties are 1 percent of annual income or $95 per person, $47.50 per child under 18, with the maximum set at $285 per family. In 2016 and beyond, the penalty will be 2.5 percent of yearly income or $695 per person, according to healthcare.gov.

Paliath, having worked in government, said it’s possible that issues related to the website and enrollment numbers could be chalked up to bad communication between different levels of government.

“However, you would think that on a project like this, with as much public attention as it was going to get and scrutiny, that there would have been some point person who would have had the ear of someone in power to do something,” she said.

Only time will tell how these recent changes will turn out.

“This is a conjecture on my part. If it was a vendor problem, they did the right thing,” added Paliath. “If it wasn’t, this won’t be the end of the story.”

mshapiro@jewishtimes.com

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