In the Eleventh Hour

The stories you’re hearing about lamp-lit, midnight pow-wows taking place in state offices are true. The states are working around the clock at a feverish pace to meet the Health Insurance Marketplace go-live date of Oct. 1, 2013. From conversations with my counterparts who are leading the marketplaces, I understand that some of the most significant concerns include:

  • System of Record: For states building their own marketplaces, the first design decision is around the system of record. Some states are electing to use the HIX itself as their eligibility system of record, funneling all eligibility determinations – tax credits, cost-sharing reductions, Medicaid, Children’s Health Insurance Program (CHIP) and Basic Health Plan – through one platform. Other states are designing their marketplaces as entry points, from which eligibility decisions flow to a legacy system for determination decisions. Either way, states are finding that the project is akin to remodeling a 747 while it’s in the air. The legacy systems need to be updated so they can coordinate and speak to the HIX. That’s a massive undertaking on its own, but it also has to be done while the HIX is still being designed.
  • The Federal Hub: State marketplace leaders are also considering the readiness and functionality of the federal hub. States will be required to check in with the federal hub for applicants’ immigration status, income level, etc. The federal hub is being built and rolled out at the same time that states are designing the rules for how their marketplaces will speak to and integrate with it. Again, it’s a bit like remodeling an airplane mid-flight.

  • Customer Service: Imagine being dropped into a foreign country at random, and not knowing if you’re going to know or speak the language when you get there. That’s what it might feel like for someone who has never before had health insurance and wants to participate in a marketplace. Most states haven’t selected the health insurance plans that will be available through their marketplaces, or loaded them into the system, so there is no way for someone to start evaluating their options so they know what they’ll be eligible for. Phone numbers and websites where people will be able to get support won’t be available until go-live. States need to be prepared for participants who might feel overwhelmed making a very personal and expensive purchase – often for the first time.
  • Capacity Planning: It’s difficult for states to plan for staffing a customer support center when there are so many unknowns: How soon are people going to reach out with questions? What types of questions will they have, and what will they need help with? It’s tough to plan for the right capacity at this stage, so many states are turning to partners who have the ability to train specialized staff and the flexibility to scale staff up and down quickly to meet fluctuating demand.

HIX preparation is nothing short of a high stakes juggling act. It takes a lot of coordination to keep every ball in the air at the same time. Drop one and all the others will be impacted, and the ability to meet the Oct. 1 deadline could be threatened.

The states I work with are rising to the challenge – and while there may be some ups and downs, there is a general acknowledgement that Oct. 1 will be go-live for open enrollment and a big day in the journey for increasing affordable healthcare coverage in America.

Kevin Walsh is the senior vice president and managing director of eligibility and insurance exchange services for government healthcare solutions at Xerox.

Spread the love

6 replies »

  1. thanks for your comments to our post. if you want state specific info you will find it with a web search that included the state and the words health insurance exchange or marketplace. they all have good info out there.
    the respective customer services avenues are also starting to be posted on those sites. as to income verification, most of that with be systematically reviewed with an excahnge link to IRS via the hub.

  2. “The Federal Hub: State marketplace leaders are also considering the readiness and functionality of the federal hub. States will be required to check in with the federal hub for applicants’ immigration status, income level, etc.”

    I thought initially there was to be no income verification?

  3. This is a great overview of general problems.. Where can I find more information about state-specific issues, though?

Leave a Reply

Your email address will not be published. Required fields are marked *