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Connector Board Discusses Path Forward for IT Systems Fix, Repeals Employer Regulations

Connector Board Discusses Path Forward for IT Systems Fix, Repeals Employer Regulations

June 16, 2014

Summary of agenda for Connector Board meeting 6-12-14

Last Thursday, the Health Connector Board met to discuss progress with the “dual track” plan to fix the eligibility and enrollment system; vote on work orders with business vendor Dell; and vote to repeal employer-related regulations.

Jean Yang began with her Executive Director’s report, with a preview of the July board meeting. In July, Connector staff plan to come to the Board with:

  • Preliminary Seal of Approval recommendations (which plans to be sold through Connector for 2015)
  • 2015 Navigator Program update
  • FY2015 administrative budget

Due to the tight timelines and high level of work ahead in the summer, Yang is also considering scheduling an August board meeting. Yang concluded her report by stating that the Health Connector is “making more progress than we have for a very long time.”

The update on the website and enrollment systems is here, and other materials are available on the Connector website, under Leadership • Board Meetings.


Health Insurance Exchange (HIX) Update

Coverage Extensions
As we reported in an earlier post, the Commonwealth received permission from federal officials to extend Commonwealth Care and temporary MassHealth coverage through December 31, 2014.

Dual Track Process: hCentive and FFM
Maydad Cohen, the new special assistant to the Governor for project delivery, overseeing the eligibility and enrollment system fixes, delivered his first presentation to the Connector Board. Cohen provided updates on progress with hCentive and the Federally Facilitated Marketplace (FFM) for Connector coverage and introduced a section about the MassHealth eligibility system. For this coming open enrollment period, which starts November 15, 2014, Connector and MassHealth eligibility and enrollment processes will be separate – however, the systems will have to communicate with each other. The vision is to implement an integrated MassHealth-Connector eligibility system in time for open enrollment in 2015.

Connector Slide: Progress made with the hCentive track for a State Marketplace 6-12-14

According to Cohen, implementation of the hCentive product is going well. The key risk areas that remain include:

  • Federal data hub integration;
  • Vendor integration (particularly Dell for enrollment and billing); and
  • Aggressive timeline and staffing challenges.

Roni Mansur is the Connector lead on the hCentive track. He stated that the Connector plans to release hCentive version ‘1.0” on June 30th and present the product to CMS in early July, an important check point that will help determine whether the Connector can use the state-based solution through hCentive or default to the FFM for the next open enrollment period.

The Connector plans to release a version of hCentive every 30 days. The state wrap (ConnectorCare) will not be included in the initial release, which is focused on core Affordable Care Act (ACA) requirements. The Connector plans to build in the capability to do ConnectorCare determinations for the July 30th version 2.0 release.

Nick Fontana, a Connector staff member, and staff from hCentive provided a live demo of what the “of the shelf” hCentive application process looks like. This application used was a slightly modified version of the federal streamlined application.

Ashley Hague is the Connector lead on the FFM track. Hague said that the Connector is also making significant progress. Should the Health Connector need to use the FFM for the next open enrollment period, the Connector would be considered a “Supported State-Based Marketplace.” Essentially, this means that while the Connector would use the FFM’s eligibility system, it would still have authority over other Exchange decisions, such as which plans to offer. One particular area of challenge is integrating ConnectorCare into the FFM will be a major challenge, as the FFM does not allow for customization.

Medicaid Eligibility Platform (MEP)
Kristin Thorn, Director of Medicaid, provided an overview of the work MassHealth is doing to revamp the previously-built HIX system to make eligibility determinations for residents potentially eligible for MassHealth. This system will be needed with both the hCentive and FFM. MassHealth is focusing on developing this system for the Medicaid MAGI population, meaning people who are required under the ACA to receive and eligibility determination based on Modified Adjusted Gross Income (MAGI), a new income methodology. In order to minimize the scope of work, MassHealth is focusing on 24 of the 180 possible MassHealth eligibility categories. People with disabilities and seniors will largely be determined for coverage outside of the MEP. Currently, the MEP is making program determinations with an 80% accuracy rate.

Another important feature of any system that will be developed is the ability to relay information back and forth – the Exchange needs the ability to transfer information about people who appear to be eligible for Medicaid to MassHealth. The Connector and MassHealth are also still considering options for the “front-door” experience, or how consumers will get to the right place to apply for and enroll in coverage.

Program & Project Budget Update
According to Administration and Finance Secretary Glen Shor, total spending on Health Connector (including Commonwealth Care) and MassHealth (including temporary coverage) for Fy2014 closely matches the Commonwealth’s original budget assumptions. Total enrollment in ACA-related Health Connector and MassHealth categories is slightly greater than the original budget assumptions. However, total per member per month spending for these categories is slightly less than anticipated. The state has added 296,686 new members to subsidized coverage since December 2013.

Health Connector Operations

Dell Marketing has worked with the Connector since 2008 on call center and back-office operations. Yesterday, the Connector Board voted to approve three work orders with Dell:

  • Build a system to process account changes (e.g., adding or removing dependents as a result of birth, marriage, or adoption; changing effective dates; updating demographic information)
  • Integrate enrollment and billing with the hCentive system
  • Integrate enrollment and billing with the FFM

The work orders run through mid-July, at which time the Connector envisions having more clarity about which track they will pursue for the next open enrollment period.

Repeal of Employer-Related Regulations

Last, the Board voted to repeal several employer-related regulations that were required under the Massachusetts health reform law, but have since been struck from law in light of the ACA.

These regulations include:

  • Employer Fair Share Contribution: requirement that employers with 11+ Full-Time Equivalent (FTE) employees offer fair and reasonable health insurance to their employees or pay an assessment (the ACA applies to employers with 50+ full time employees)
  • Section 125 Requirement: requirement that employers provide a Section 125 plan that allows employees to pay health insurance premiums using pre-tax wages (which is prohibited under the ACA)
  • Free Rider Surcharge: assessment on employers with 11+ FTEs that fail to provide a Section 125 plan
  • Health Insurance Responsibility Disclosure (HIRD): Employer HIRD form requires employers with 11+ FTEs to submit information about their compliance with the Section 125 requirement; employee HIRD form is collected by employers from each employee who declines to enroll in employer-sponsored insurance (ESI).

The next Connector Board meeting is scheduled for Thursday, July 10th at 9:00am, 1 Ashburton Place, 21st floor.

    -Suzanne Curry