Health Care Exchange (11/22/2013)

Final
STAFF SUMMARY OF MEETING

HEALTH CARE EXCHANGE

Date:	11/22/2013	ATTENDANCE

Time:	09:02 AM to 12:46 PM	Gardner	X
		Lundberg	X
Place:	SCR 356	Nicholson	*
		Primavera	X
This Meeting was called to order by		Roberts	X
	Senator Aguilar	Stephens	*
		Tyler	X
This Report was prepared by		Ulibarri	X
	Elizabeth Burger	McCann	X
		Aguilar	X
		X = Present, E = Excused, A = Absent, * = Present after roll call

Bills Addressed:		Action Taken:
Update on the Colorado Health Benefit Exchange		Witness Testimony and/or Committee Discussion Only

09:03 AM -- Update on the Colorado Health Benefit Exchange

Patty Fontneau, Executive Director, Connect for Health Colorado, updated the committee on the implementation of Colorado's health insurance exchange. She described additional functionality added to the exchange since it began operations. She noted that there were problems when the exchange first was rolled out, including problems with account creation and error messages, but stated that the problems have largely been resolved. She discussed the plans available through the exchange and noted that there is a 200-person help center located in Colorado Springs to assist consumers in navigating the exchange. A handout was distributed to the committee (Attachment A).

131122 AttachA.pdf

09:13 AM

Ms. Fontneau continued to describe the assistance that is available to people seeking coverage through the exchange and discussed its technical components. Ms. Fontneau noted that Colorado's exchange is not part of the healthcare.gov website. She explained that CGI is one of the vendors for Colorado's system as well as the federal system, and that CGI has been responsive and willing to implement fixes. She noted that Colorado's system is a customized, commercial off-the-shelf program, and that approach was selected to reduce long-term costs. She discussed the security specifications for the exchange.

09:18 AM

Ms. Fontneau noted that there have been over 500,000 visitors to the website to date. She reiterated that there were problems with account creation as well as intermittent error messages in the first week of the exchange's operation. She explained that about 1 to 2 percent of visitors are still receiving error messages on a daily basis and described the efforts the exchange is undertaking to resolve those messages. She noted that as of October 16, there were over 70,000 accounts created. She explained that anonymous shopping, the anonymous calculation of financial assistance, and the provider directory are the most popular features of the website, and that those features are not generally available in other states. She further discussed the ongoing enhancements being made since the website's launch, including information on quality, the medical provider directory, the ability of individuals to apply for tax credits through the website, enrollment data interfacing with carriers, and the financial management system.

09:24 AM

She discussed the financial assistance process. She explained that the exchange cannot provide customers with a premium tax credit if they are eligible for Medicaid, and the state must make the Medicaid eligibility determination. She relayed a number of metrics associated with the exchange from October 1 to November 16, including: 500,000 unique website visitors; 71,497 customer accounts created; 6,000 people enrolled in private health insurance; 47,309 Medicaid enrollments; 57,821 calls and chats serviced by the exchange, with an average wait time of 5 minutes and 23 seconds; 99.7 percent of web pages serviced within 5 seconds; 99.8 percent system availability; 44 percent of calls answered within 20 seconds; and average chat and call length of 16 minutes and 54 seconds. She discussed why there has been a large number of Medicaid enrollments and a relatively smaller number enrolled in private health insurance through the exchange. She discussed the long length of assistance calls and call wait times and the steps the exchange is taking to reduce the wait times.

09:29 AM

She discussed the enrollment trajectory for the exchange and noted that interest in the exchange is continuing to grow. She discussed the exchange's outreach and communications efforts, noting that the exchange launched a $4 million enrollment campaign on October 1, and marketing occurs through a number of mediums, including TV, radio, print, billboards, and search engines. She noted that there are other organizations doing separate outreach campaigns, and the exchange is not connected with as series of advertisements known as the "Got Insurance?" campaign. She discussed the demographics of the population that is enrolling in the exchange.

09:33 AM

Ms. Fontneau discussed the finances of the exchange. She noted that $177 million was awarded to the exchange through federal grants. The exchange has spent $50 million for technology, grants to other organizations, and call center infrastructure. She noted that the technology expenditures will continue to grow and that technology payments were due when the system was delivered. She noted the exchange is meeting with the Joint Budget Committee in December. She discussed the revenue for the exchange, noting that there are a variety of sources, including enrollment-based revenue. She noted that administrative fees are 1.4 percent in 2014, compared to 3.5 percent for the federal exchange. She noted that the fee doesn't account for depreciation, and explained that the exchange has established a technology reserve to cover costs of technology depreciation. She discussed future revenue opportunities, including supplemental products, carrier tax credit donations, website advertising, cost sharing with other states, and foundation grants.

09:39 AM

Ms. Fontneau described the continuing areas of focus for the exchange, including improving the speed of financial assistance applications, implementing a long-term financial application solution, improving support to brokers and businesses, improving consumers' experiences, reaching customers who have received Medicaid denials, reaching account holders who have not signed up, addressing developments from Washington D.C., communicating and coordinating with partners, and conducting enrollment drives. Senator Aguilar asked how many people were enrolled in CoverColorado who have transition to the exchange, and how the transition has gone. Ms. Fontneau noted that the exchange has been working closely with CoverColorado to communicate to their enrollees. Ms. Fontneau addressed questions from the committee regarding the length of the enrollment application, stating that initially there were questions being asked related to qualifying for Medicaid due to disability, and those questions have since been suppressed. She stated that the exchange is continuing to work with the Department of Health Care Policy and Financing to streamline the application. The committee continued to discuss the enrollment of individuals in the exchange who had previously been enrolled in CoverColorado.

09:54 AM

The committee discussed the enrollment of individuals in health plans through the exchange and whether there is information on how many individuals are actually enrolling in coverage. Senator Roberts asked for information about premiums for plans in resort communities. Ms. Fontneau noted that individuals who live in high cost areas and who meet the income requirements will receive larger tax credits to purchase coverage through the exchange, and the committee discussed how the tax credits are distributed.

10:03 AM

Ms. Fontneau responded to questions from Representative Gardner regarding eligibility for premium tax credits. The committee further discussed the Got Insurance ad campaign and whether the exchange had done enough to distance itself from that campaign.

10:15 AM

Sue Birch, Executive Director of the Department of Health Care Policy and Financing, discussed the involvement of the department in the roll-out of the exchange. She discussed the PEAK application for enrollment in Medicaid and explained that the federal government requires a Medicaid denial letter in order to determine a person eligible for an insurance tax credit. She stated that the department is working to streamline the Medicaid application process and is working with the federal government to ensure that applications are complete when they are submitted. She discussed further enhancements to the enrollment process that the department plans to implement in the future. Ms. Birch responded to questions from the committee regarding Medicaid enrollees and projections of how many new Medicaid enrollees there may be as a result of the implementation of the exchange. She offered to provide information to Senator Lundberg regarding the breakdown of new Medicaid enrollees and whether they would have previously been eligible for Medicaid coverage. Antoinette Taranto, Department of Health Care Policy and Financing, came to the table to respond to Senator Lundberg's questions regarding Medicaid eligibility. She clarified that 47,000 new individuals have been enrolled in Medicaid through the exchange, and all of these enrollees are eligible for Medicaid coverage as a result of the Medicaid expansion effective January 1, 2014.

10:33 AM

The committee discussed the Medicaid eligibility enrollment process, and noted that individuals have to complete the Medicaid application process before they are allowed to purchase a plan through exchange if they want to apply for a tax credit. Individuals who do not want a tax credit do not have to complete the Medicaid eligibility process. Ms. Birch noted that it is federal law that a person have a Medicaid denial letter for a person to get an advance federal tax credit. Representative McCann asked for more information about the denial process. Ms. Birch noted that 70 to 80 percent of individuals are going through the PEAK application process and getting a real-time eligibility determination. She noted that there were 43,000 applications submitted from October to November and discussed the system improvements that are accelerating the eligibility determination process. Ms. Birch noted that the federal government is requiring a single, streamlined application with the exchange by 2016, and Colorado will work to implement it in the next year.

10:40 AM

Ms. Birch discussed efforts to bring efficiencies to the system, implement regional care collaboratives, and transform the delivery of health care. She said that the department and the Colorado Medical Society are pleased with the progress being made. Senator Roberts expressed concern about lack of providers and providers being overwhelmed by new Medicaid patients. She asked about clients printing their own Medicaid cards and the possibility of fraud, and Ms. Birch stated that they can order their cards online but not print them out themselves. Representative Gardner discussed the implementation of the Affordable Care Act and the Medicaid expansion. Ms. Birch further discussed the number of new Medicaid enrollees, how many people were referred through the exchange website, and whether the Medicaid benefits align with the essential health benefits required of private plans offered through the exchange.

10:54 AM

Ms. Fontneau continued to respond to questions from Representative Gardner regarding the Got Insurance campaign, and how the exchange works with other entities regarding advertising campaigns to promote insurance coverage and the use of the exchange. Ms. Fontneau noted that there are requirements for advertisements if the exchange's logo is used in an ad campaign. Ms. Fontneau responded to questions regarding whether Colorado's system could be replicated at the federal level, and noted that the system could possibly be replicated in other states. The committee continued to discuss the exchange board's response to the Got Insurance ad campaign. Committee discussion continued.

11:05 AM

Ms. Fontneau continued to respond to questions from the committee regarding error messages received by committee members who attempted to access the exchange website. Ms. Fontneau explained that individuals can request that their exchange accounts be cancelled. Ms. Fontneau and Senator Lundberg discussed the enrollment of individuals in the exchange with the assistance of insurance brokers. Ms. Taranto came to the table to respond to questions from Senator Lundberg regarding Medicaid enrollments.

11:19 AM

Representative Tyler discussed the number of accounts that had been created versus the number of individuals who had enrolled in health insurance, and whether the exchange was prepared for an increase in enrollment in December. Ms. Fontneau further addressed questions regarding whether Colorado is working with other state exchanges on implementation.

11:28 AM

Ms. Fontneau continued to respond to questions from the committee regarding enrollments. Senator Roberts asked Ms. Fontneau to provide additional information about whether individuals who choose insurance through the exchange ultimately enroll in the plan. Senator Roberts asked about the age of persons enrolling versus the age of the uninsured population overall. Ms. Fontneau talked about the risk pool and the impact on rates. She discussed the assumptions of the carriers and how they set rates, and that the impact on future rates depends on the assumptions of the carriers. Gretchen Hammer, Chair of the Connect for Health Colorado Board of Directors, discussed the six-month open enrollment period and said that full data won't be available immediately. Senator Aguilar discussed the pent-up demand in older, sicker persons who are likely to shop first.

11:39 AM

Representative Ginal asked about the waiting period for new residents to enroll. Ms. Fontneau said that new residents have 30 days to notify the exchange after moving to the state and purchase insurance. Representative Ginal and Ms. Fontneau discussed the availability of providers and the provider directory. Senator Lundberg asked about the administrative fees and if they really are more efficient than the federal exchange once you back out the funds from CoverColorado being provided to the exchange. Ms. Fontneau discussed the exchange's multiple funding streams and said that even accounting for the other fund sources, it is more efficient. Senator Lundberg asked about compensation for brokers. Ms. Fontneau said that brokers receive compensation from the carriers and that the compensation is the same inside and outside the exchange. Senator Lundberg asked about the premium tax credits and how they interact with other tax credits a person may be eligible for. Senator Lundberg asked about current spending, revenues, and assets and for a bottom-line figure on total spending. Ms. Fontneau said the exchange has spent about $50 million and it has zero in the bank because they pull down grant funding as they spend it.. She discussed how the initial funding is for the implementation and for the first year of operations. Representative Stephens asked about the future role of brokers. Ms. Fontneau said that purchasing health insurance is complicated and that there is a role for brokers in helping people navigate the system. She stated that 1,400 brokers have been trained and certified. Ms. Fontneau discussed ways that brokers can expand their customer base and the services that they can provide by working through the exchange. Representative Schafer asked about the responsibility of brokers to inform consumers about policies that do not comply with the essential health benefits.

11:58 AM

Commission of Insurance Marguerite Salazar discussed the cancellation of policies that were not compliant with the federal Affordable Care Act, as well as plans that were discontinued as a result of carrier business decisions. She discussed how the cancellation notices are required to inform people of options, and how some letters did give the option for an early renewal. Representative Gardner asked for clarification about what was happening with plans in Colorado and whether Colorado will allow existing plans to be continued as put forth by President Obama. Commissioner Salazar said that they are staying the course and will not go through the complicated process to renew plans that are being cancelled.

12:22 PM

Commissioner Salazar responded to questions from Senator Schwartz regarding geographic ratings of the state for insurance purposes and in particular the grouping of certain areas into the "resort" rating area. The committee discussed the subsidies available for individuals who are in high cost areas. The committee continued to discuss CoverColorado, and the funding of CoverColorado and the health exchange.

12:35 PM

Commissioner Salazar responded to questions from the committee regarding the extension of the enrollment period for plans under the Affordable Care Act for 2015. Senator Lundberg asked for more clear metrics about how many individuals are signing up for coverage through the exchange.

12:46 PM

The committee adjourned.