Saving Maryland’s ACA Exchange: What Needs to Happen

It was a tale of two exchanges for Maryland and Connecticut when it came to the creation of their own insurance marketplaces under the Affordable Care Act.

Maryland’s glitch-ridden site crashed upon launch on Oct. 1 and remained plagued by malfucntions throughout the six-month open enrollment period that made it hard for residents to sign up for coverage.  The story just a few states away is much different: Connecticut has been the darling of the state exchange system, widely regarded as a success with nearly 200,000 enrollees.

After spending more than $125 million on its problematic exchange, Maryland lawmakers new something had to give. And after much speculation, the state legislature voted Tuesday to adopt the technology used by Connecticut’s Access Health system, developed by the federal government and free to use. The state will negotiate a $40-to-$50 million contract with Deloitte to design a new website ahead of next November’s open enrollment period, according to Josh Sharfstein, secretary of the Maryland Department of Health and Mental Hygiene and chair of the Maryland Health Exchange Board.

“The hard work of getting so many Marylanders enrolled was made even tougher because Maryland’s health exchange website did not meet expectations — a source of great frustration, especially for those who were trying to obtain healthcare for the very first time,” Maryland Gov. Martin O’Malley and Lt. Gov. Anthony Brown said in a release. “Our Administration has not succeeded at every first try, but we have never given up. We learn from both success and failure. The vendors we hired failed to build us the platform they promised. So now that the first open enrollment period has ended, we’ve decided to upgrade our website.”

Kevin Counihan, director of Access Health, says as of right now, Maryland is just taking the code behind Connecticut’s exchange, but that is a small part of what made it a success.

“They’re currently negotiating a memo of understanding about the code,” Counihan says. “Implementing these exchanges is really complicated—there are the technical pieces, the staffing piece, the vendor management piece, the outreach and marketing. This isn’t ‘Field of Dreams’—if you build it, it doesn’t mean they will come.”

But Sharfstein isn’t worried, saying it was technology that plagued the Maryland exchange system, not customer service and marketing. “We have a high-functioning consumer assistance network and marketing campaign; the technology piece in Maryland is what has been most problematic.”

The ACA’s inaugural open enrollment period is over, but Paul Hencoski, leader at KPMG, one of the vendors for Access Health, says 2015’s open enrollment season is right around the corner.

“What they can do may not be possible by November, and what is achievable, is laying out a tight plan that allows them to achieve whatever it is in 2015, with a full conversion by 2016.”

Sharfstein assures the technology will “definitely” be in place by next open enrollment period.

What Happens to Maryland’s Enrollees?

As of Tuesday, Maryland had enrolled 63,002 residents on qualified health plans, without Medicaid enrollees, which bring the tally up to 295,000, Sharfstein says.

He adds there are still “potentially” several thousand residents who are in an enrollment limbo, unable to complete the process.

“We allowed them to call and register for extra assistance ahead of April 1 so we can call them and work through whatever problems they are having,” he says, adding that this process will be ongoing.

But this year’s residents, who enrolled on the flawed Maryland site, won’t need to transfer to next year’s new exchange, Sharfstein says.

“When it’s time to renew, they will get a notice, go to the new system and log on,” he says. “We aren’t doing a data transfer.”

Hencoski says that the process should be “seamless” in his experience, save for those who are stuck in the system.

“Part of that data conversion process means that team, responsible for implementation, would do an analysis and close out any duplicates [or issues],” he says. “I’d expect the state to do some outreach to be sure applications are handled correctly.”