‘Odious, embarrassing’ system driving down health sign-ups

By Katie Kerwin McCrimmon

Colorado has no quick fix for a seemingly endless Medicaid application that health exchange board members believe is driving away customers and decreasing the number of people buying health insurance through Colorado’s new multi-million dollar health exchange.

Finger-pointing between state and exchange managers escalated on Monday as exchange board members said Colorado should have been better prepared and that the state’s lagging system is an embarrassment.

“It’s painful. It’s odious. It’s embarrassing to have to go through all these questions that are not necessary if they’re going to get kicked out anyway,” said Nathan Wilkes, an IT expert and board member for the state’s health exchange, Connect for Health Colorado.

State and health exchange managers are now eyeing Kentucky as a model and are proposing a new, streamlined application that would be far less cumbersome for customers. Colorado was supposed to build a system like this, but sparring between the state of Colorado and exchange managers over IT systems prompted Colorado to ditch that plan back in February. (Click here to read more.)

Now, state and exchange officials are not saying how much more Colorado will have to spend to build a streamlined system that will be much more friendly to consumers. So far, Colorado has spent nearly $200 million building its own exchange. The soonest a revamped system would be up and running is next October, long past the deadline for consumers to sign up for health insurance for 2014.

By the numbers
  • 3408 – number of plans sold in Colorado in October
  • 34,168 – number of new Colorado Medicaid clients enrolled in October
  • 48,995 – number of enrollments in Washington (6,390 private, 42,605 Medicaid)
  • 37,003 – number of enrollments in New York (13,313 private, 23,717 Medicaid)
  • 31,545  – number of enrollments in Kentucky (5891 private, 25,656 Medicaid)
  • 90 minutes to 2 hours: time it’s taking for experienced people to fill out Colorado’s mandatory Medicaid form
  • 17 days – time one Boulder man told state authorities he’s been stuck in a black hole waiting for a response
  • 30-to-50% – how often exchange managers contend people are getting a real-time acceptance or denial for their Medicaid application
  • 50-to-60% – how often state officials contend people get real-time Medicaid acceptance or denial
  • 95% – how often people should be getting real time Medicaid acceptance or denial
  • $200 million – approximate cost to build Colorado’s health exchange
  • Cost for new Colorado “streamlined application” – no estimate yet
  • Dec. 15: deadline to select health insurance plan in order to get coverage by Jan. 1
  • 138,000: mid-level goal for number of people Colorado pledged to sign up for health insurance in 2014

Both state and exchange managers said they don’t yet have a proposal to solve the short-term problems that are dogging consumers and causing headaches for brokers and health coverage guides.

State managers say they are working to improve the state’s clunky Medicaid questionnaire that probes applicants about everything from their assets to possible disabilities. The soonest they say they can make changes for this year is December.

Gov. John Hickenlooper’s deputy chief of staff, Kevin Patterson, said during an exchange committee meeting Monday that Medicaid managers are trying to fix the problems, but that they are limited because the state has been sued over its long-troubled benefits system in the past. If Colorado inaccurately qualifies or denies people for Medicaid, the state could be on the hook for all costs.

“We are working together to figure out what else we can do to make this go as quickly as possible,” Patterson said. “We’re trying to make sure we’re coordinating with C4 (Connect for Health) in what ways we can move forward.”

Lorez Meinhold, deputy executive director for Colorado’s Medicaid programs, said Hickenlooper’s highest priority is to get as many people qualified for both public and private health insurance as possible.

“This is a brand new process for both of us (the state and the exchange),” Meinhold said. “We hope to see both the real time eligibility numbers go up as well as the lessening of time to get those denials. Generally, it’s happening in a shorter period of time.”

Meanwhile, the clock is ticking. Customers who want coverage starting Jan. 1, 2014 must sign up for health plans by Dec. 15.

While the federal health exchange, www.healthcare.gov, has notoriously flopped due to IT problems, sales from Colorado’s home-built health exchange have lagged due to some high prices in mountain resort areas (click here to read more) and the cumbersome Medicaid application.

An exchange IT specialist demonstrated on Monday how the application worked. Skipping multiple steps, he was only able to move part way through a fake application in about 45 minutes. Starting this week, Coloradans are supposed to be able to apply for federal tax subsidies online to help them reduce their health care costs. But, first all applicants must complete the Medicaid application so they can either qualify for the insurance plan for low-income and disabled people or get a “denial” and move forward with buying private health insurance.

Complicating matters even more is that the federal government’s “data hub,” which is supposed to help state exchanges verify customers’ incomes, Social Security numbers and immigration status, has not been working.

“The hub has been down a lot over the last couple of weeks. It has not been available to the other states. There’s been a fair amount of trouble with it,” said Patty Fontneau, the exchange’s CEO and executive director.

Board members were furious Monday at the seemingly slow-motion response to problems with Colorado’s exchange.

Dr. Mike Fallon said Colorado needs an immediate solution or customers won’t be able to buy health insurance by Jan. 1.

“I’m concerned as to what’s happening today,” Fallon said. “If I had to sit down and put in (information) for my four kids for a program that I know I don’t qualify for, I’d be done. This isn’t Travelocity. This isn’t anything close. I think I’m getting a better picture of why our enrollment is challenged,” Fallon said.

Exchange officials have not released new sales numbers, but as of Oct. 26, only 3,164 people had actually purchased plans through Connect for Health. By Oct. 28, Washington State had enrolled nearly 50,000 people in Medicaid and private plans, while New York logged 37,000 enrollments by Oct. 24 and Kentucky reported nearly 32,500 sign-ups in its first month.

Colorado officials have projected that they would have more than 130,000 customers by the end of 2014. The cutoff for buying any health insurance for next year is March 31. Customers who fail to buy it could face financial penalties.

Fallon and fellow board members Nathan Wilkes, Richard Betts and Ellen Daehnick all said Monday they want a quick solution. Wilkes suggested allowing people whose incomes are likely to disqualify them for Medicaid to move forward with selecting private health insurance. If it turns out that they qualify for Medicaid, they could be added to the program retroactively. But once people miss the window to buy health private coverage, they’ll lose out.

Daehnick questioned why exchange managers were not better prepared for the problems with the Medicaid application.

“Why is this problem new to us? Why didn’t we have a plan in place?” she asked. “Why didn’t we take steps to solve this problem six months ago?”

Daehnick is one of the newest members of the board. She joined this summer well after managers and consultants had designed the architecture for Colorado’s exchange. Nonetheless, there have been plenty of warning signs of trouble.

Solutions has reported extensively on potential IT problems and sparring between the state and exchange managers that prompted a mediator to have to step in this spring. (Click here to read more.)

Colorado is one of 14 states operating its own health exchange. In many other states, the exchange is part of the state government, but in Colorado, lawmakers deliberately set up Connect for Health as a public entity outside of state government.

On top of taking hours or days to complete, the Medicaid application is failing to provide real-time results to customers in as many as 70 percent of cases, according to health exchange managers. On Monday, they said customer service agents can only get real-time determinations of whether a customer will qualify for Medicaid about 30 to 50 percent of the time.

One potential customer from Boulder, a therapist named Andy Rose, told exchange managers on Monday that he’s been waiting 17 days and can’t get a response.

Without a solid answer about whether he qualifies for Medicaid, he cannot move forward and said he’s stuck in a black hole.

Medicaid managers contend that their system is performing better and the exchange managers say it is. They say the system produces real-time results 50 to 60 percent of the time. Exchange managers say that’s optimistic and that they did not anticipate the problem because state managers promised much better results.

“We expect a higher percentage (of real-time determinations) and that’s what we were told (to expect),” said Lindy Hinman, chief operating officer for Connect for Health. “It isn’t the operational experience that we expected.”


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