A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Connector Moves Forward with hCentive, Plans Outreach Activities, and Repeals Employer Health Care Regulations

Connector Moves Forward with hCentive, Plans Outreach Activities, and Repeals Employer Health Care Regulations

August 14, 2014

Connector Summary of Dual Track Implementation 8-14-14

As announced earlier this month, Massachusetts is moving forward with a state-based system for its health insurance eligibility and enrollment system and consumer-facing website. Today’s Connector Board meeting focused on the progress made in building this new system and the Connector and MassHealth’s plans for coverage transitions and outreach and enrollment leading up to the next open enrollment period. The Connector Board also voted on the repeal of some obsolete employer-related regulations.

The Connector ran through a live demonstration of the work-in-progress website, showing that it is capable of processing an application form and responding with the proper eligibility decision. Still, there’s lots more to do, including get the word out to almost half a million residents about the need to renew their coverage.

Materials from the meeting can be found on the Connector’s website, under About – Leadership – Board Meetings. The key presentations are the update on the web site and eligibility system, and a deck on the outreach and communications strategy.  Our detailed report takes just a click.

HIX Project Update

On July 30th, Massachusetts installed the iteration 2.0 of the hCentive software. It’s now able to determine eligibility for and effectuate enrollment in the state wrap (ConnectorCare) program, which provides supplemental subsidies on top of federal tax credits and cost sharing help. It also can connect with Dell, the state’s vendor for plan enrollment and billing purposes.

In early August, state policymakers demonstrated the capabilities of the new system for federal officials, and on August 7th, the Commonwealth made the decision, with the support of the federal Centers for Medicare and Medicaid Services (CMS), to move forward exclusively with hCentive and drop the Federally-Facilitated Marketplace (FFM or healthcare.gov) contingency plan.

Connector: Consumer experience overview slide 8-14-14

The hCentive software will enable the state for the first time to have a single “front door” for consumers to apply for Connector programs and MassHealth. It will replace the paper-based, manual enrollment system that existed for subsidized coverage programs until now.

hCentive release 3.0, slated for release on August 30th, will have more capabilities, including additional notices, back office functions, and verifications. Should there be any problems with hCentive 3.0, the state will revert to release 2.0, which is already functional and meets all federal Affordable Care Act (ACA) requirements. In addition, health insurance plans are already loaded into hCentive, except for the rates, which are expected to be finalized tomorrow.

hCentive 2.0 is also able to assess individuals and households for potential MassHealth eligibility. If a consumer appears eligible for MassHealth, his or her information is sent to the MassHealth Eligibility Platform (MEP) to make a MassHealth eligibility determination. Should the person be eligible for MassHealth, he or she will receive a letter and enrollment information from MassHealth, in perhaps 3 days. In response to a board question, the staff indicated that they are looking into using email to inform people as well.

Should the person not be eligible for MassHealth, he or she is sent back to the Connector to complete his or her application and enrollment. Once the hCentive system receives an answer from the MEP about whether or not a person is eligible for MassHealth, hCentive turns off its Medicaid assessment function. This will prevent consumers from being caught in an endless loop of bouncing back and forth between the Connector and MassHealth (which has been an issue on healthcare.gov).

Importantly, in order to do this, hCentive needs to communicate with the MEP and the MEP needs to communicate back to hCentive. This functionality is working in the current version of hCentive. In addition, the MEP needs to make accurate program eligibility determinations. Previously, the MEP only had a 40% pass rate in determining eligibility for the most complicated cases. Now, MEP’s accuracy rate is at 93%, and will continue to be tested.

To ensure readiness for fall 2014, MassHealth reduced the scope of aid categories for which the new system will determine eligibility – from 252 to 24, the most critical categories that must be determined using Modified Adjusted Gross Income (MAGI), per the ACA.  For perspective, about 1.2 million of the current 1.6 million MassHealth members will require a MAGI program determination. People with disabilities and the elderly will not be determined through the MEP; they will continue to use the current application and enrollment process.

As IT development, production and testing continue, so does enrollment in temporary MassHealth coverage, the stopgap coverage for those who have applied for subsidized coverage since October 2013 and were not able to get an eligibility determination. As of August 9th, 267,000 people are enrolled in temporary MassHealth coverage. The Commonwealth has paid $201.4 million in claims (before federal reimbursement) for this population between January1-August 2, 2014. Glen Shor, Secretary of the Executive Office of Administration and Finance reiterated that the cost of providing coverage through temporary MassHealth and the continued Commonwealth Care programs remains within the budget appropriations for Fiscal Year 2014. Shor will continue to manage and report on Fiscal Year 2015 costs for this coverage. The Commonwealth is meeting with CMS tomorrow to request approval for enhanced federal matching funds for $80 million in new IT project costs.

Next, Connector staff provided a live demonstration of the hCentive system. A test case, provided by the federal CMS for testing purposes, was entered in while the board watched. The system was able to complete the end-to-end application, eligibility determination, and enrollment process for a family in which the parents are eligible for state wrap (ConnectorCare). The children were correctly found eligible for MassHealth.  Several Connector Board members provided feedback on wording for application questions and phrasing. Jean Yang responded that this feedback is important yet the Connector plans to make minimal customization of the forms, which are based on the federal versions.


Outreach and Communications Strategy

The next open enrollment period (November 15, 2014 - February 15, 2015) is critical to ensuring that Massachusetts residents transition to appropriate, ACA-compliant coverage. The Connector and MassHealth – in collaboration with community partners and stakeholders – plan to outreach to 450,000 Massachusetts residents to get the word about open enrollment and the need to renew their coverage.

Connector outreach overview slide 8-14-14

The Connector and MassHealth seek to reach the following populations:

  • Transition populations: those who need to transition from temporary MassHealth, Commonwealth Care and current Qualified Health Plans (QHPs) to new coverage
  • Remaining uninsured
  • Currently insured and newly seeking coverage through the Health Connector

The Commonwealth will focus its outreach efforts on transition populations who need to reapply for coverage – temporary MassHealth, Commonwealth Care and QHP enrollees. The Connector and MassHealth’s approach to messaging includes:

  • Acknowledge and apologize for last year’s problems
  • Call to action: you need to take advantage of ACA open enrollment and submit a new application
  • Appropriate variation by population with a consistent overarching theme

Connector Outreach Goals ofr 2014 open enrollment 8-14-14

The Connector and MassHealth – along with community partners – will engage in an outreach campaign that includes the following components:

  • Direct member contact: mailings, outbound phone calls, door knocking
  • Community enrollment assistance: Navigators and certified application counselors (CACs), community enrollment fairs, collaboration with community partners
  • Media and public education: radio, TV, print; earned media, corporate sponsorships; “town halls” and “road shows.”

The Connector has selected 15 Navigator organizations to provide enrollment assistance and outreach. The ACA requires all state-based marketplaces to run and fund a Navigator program. Last year, the Connector funded 10 organizations. The increased number of organizations enables a broader reach in most regions of the state.

HCFA Outreach campaign slide 8-14-14

In addition, Health Care For All will partner with the Health Connector for a grassroots public education campaign – including door knocking, community events and outreach, ethnic and local media campaigns, implementation of an online system for CACs and navigators to discuss and troubleshoot issues they are seeing on the ground, and more.

The Health Connector call center will also participate in outreach for the next open enrollment period through an outbound calling campaign to all transitioning populations and increased inbound call center staffing to handle expected increased call volume during open enrollment. Outbound calls will also include robo-calls – last year’s results show that people are more likely to listen through an entire robo-call message. The Board voted to approve a $4.1 million inbound call center work order and a $3.9 million outbound call campaign work order with Dell, the Health Connector’s customer service vendor.

Repeal of Employer-Related Regulations

At its June meeting, the Connector Board voted to preliminarily approve for comment the proposed repeal of employer-related regulations,  which had been implemented under the 2006 Massachusetts health reform. These regulations include the Fair Share Contribution, Section 125 requirement, Free Rider Surcharge, and Health Insurance Responsibility Disclosure (HIRD). The Health Connector received no comments on the proposed repeal of these regulations.  Today, the Connector Board voted unanimously on the final repeal of employer-related regulations.

The next Connector Board meeting is scheduled for Thursday, September 11th at 9 am at 1 Asbhurton Place, 21st floor.

  -Suzanne Curry