Sun Investigates

Troubled health exchange must continue to serve

Pregnant and about to lose her health insurance, Genevieve Acker was eager to buy new coverage on the Maryland health exchange.

But seven weeks after she picked plans on the Maryland Health Connection, she remained without insurance cards for herself, her husband and 2-year-old daughter. The insurer she picked told her it was never notified by the exchange, which kept telling Acker the problem would be fixed.


"I got the runaround time and time again," said the New Market resident.

That was a common refrain during open enrollment, and one that helped exchange officials decide to ditch the website that never worked properly after its disastrous Oct. 1 launch. But officials must continue to make do with the old system even though the enrollment period ended in March and the new one doesn't start until November.


Officials are working on a new site but need to keep enrolling a smaller but perhaps more complex set of enrollees — the thousands qualifying for Medicaid or having a change in work or family status, who can sign up year-round. Others found their insurance inexplicably dropped. And now that officials have had time to review, they've discovered another 1,000 people inappropriately enrolled in Medicaid and others whose applications contain a discrepancy.

"There is absolutely no downtime at this point," said Alison Walker, a spokeswoman for the exchange. "People may think open enrollment is closed, but people still need insurance. They get married or have babies, they stop being eligible for Medicaid. It's still nonstop."

About 30,000 people have signed up for coverage since the end of open enrollment, according to the latest data reported by the exchange on May 16. Another report is due June 27. That brings the total enrolled to about 343,000, all but about 68,000 in Medicaid.

Other states that didn't get their exchanges right the first time also are figuring out how to keep an old site going while starting up a new one. However, Oregon, for example, doesn't plan on trying such a risky venture again. It will join the federal health exchange.

Maryland hired Deloitte Consulting on a contract worth between $40 million and $50 million to build a new exchange using technology adopted from the one in Connecticut. Meanwhile, Optum/QSSI has a contract worth up to $14 million to maintain the current website after the state cut ties with its former prime contractor, Noridian Healthcare Solutions.

One analyst following the exchanges' rollouts said operating two sites simultaneously is a "huge challenge."

"An extraordinary level of effort is needed to coordinate and sequence the interdependent activities among state and federal staff, multiple contractors, marketplace operations and project tasks," said Rick Howard, a research director at Gartner, an information technology research and advisory company.

"Adequate testing of the new site will depend on the availability of the same personnel who are essential to the day-to-day marketplace operations, including managing enrollment changes, payment reconciliations and reducing backlogs," he said.


Such an undertaking is a higher risk than moving to the federal site, Howard said.

The state wants to create its own site so that it can include Medicaid enrollment, which isn't offered on the federal exhange.

In addition to "special enrollments," or those who have had a change in their family or work status and now need insurance on the exchange, officials have found unexpected problems with prior enrollments.

Some people eligible for Medicare or already enrolled in the federal health program for seniors inadvertently signed up through the exchange for Medicaid, the federal-state health program for low-income people.

The exchange sent a letter to about 1,000 such people informing them that: "You do not qualify for this coverage." The letter tells them there might be some reduced Medicaid benefits available, but those are largely limited to certain low-income or disabled people or those acting as caregivers to a grandchild, for example.

An unknown number of people also are being notified in Maryland that they need to provide further documentation of what they attested to in their insurance application on the exchange.


Walker said consumers will have 90 days to provide proof of their income or immigration status or other information once they are notified, or risk losing their coverage. The officials will not know until later this year how many actually lose coverage.

There also were 18,680 people who reported that they had trouble signing up for coverage during open enrollment and asked for more time to sign up. Walker said all were contacted and about 7,000 have been enrolled.

Walker said the goal is to make the new exchange website a "smoother" experience.

To get that site running in time for the next open enrollment in November, officials fast-tracked some contracting decisions without an open round of bidding or a public hearing. And exchange officials still need federal officials to sign off on the new work, which is largely being done with federal dollars.

The switch is on track, according to testimony given recently to the exchange board by Isabel FitzGerald, state information technology secretary who stepped in to oversee the end of the first open enrollment and the changeover. Another update is expected June 24, when the exchange board holds its annual meeting, though no agenda was available this week.

But it's little consolation to people like Acker that a brand-new functional site is on the way.


She began calling the exchange April 21, weeks before her 26th birthday, when she would no longer be eligible to remain on her father's health insurance policy.

She said she picked a subsidized CareFirst BlueCross BlueShield plan for herself and her husband and enrolled her 2-year-old daughter in Medicaid. She was told she'd get her private insurance cards at the end of May for coverage beginning June 1. Her daughter was supposed to get her card immediately.

No cards came, so Acker said she called the exchange again and again through May, "in an attempt to get answers and rectify the situation, terrified that my young daughter would go without health insurance when her plan ended at the end of May."

She said the issue was not resolved, "and in the process of trying to figure out what was going on with her insurance, I find out that they never sent my husband's and my information to BlueCross BlueShield and we possibly wouldn't have our insurance on June 1st when promised."

She said she was assured five different times that the problems had been resolved. Finally, her daughter's card came. She's still waiting for hers and her husband's.

In the meantime, she said, "I had to get on Medicaid in order to be able to go to the doctor this month."