Date: 07/15/2015

Final
Discussion of Marketplace for Next Open Enrollment Period

HEALTH CARE EXCHANGE

Votes: View--> Action Taken:
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11:48 AM -- Discussion of Marketplace for Next Open Enrollment Period

Mr. Patterson, Adele Work, Chief Information Officer at Connect for Health Colorado, Marcia Benshoof, Chief Strategy and Sales Officer at Connect for Health Colorado, and Adela Flores-Brennan, member of the Connect for Health Colorado Board of Directors, came to the table. Mr. Patterson distributed a document to the committee that addressed prior questions brought up at prior committee meetings (Attachment E) and a presentation on the next open enrollment period (Attachment F).

150715 AttachE.pdf150715 AttachE.pdf150715 AttachF.pdf150715 AttachF.pdf

Ms. Work discussed some of the planned and unplanned challenges that arose during the last open enrollment. She discussed some of the technology challenges, including difficulties processing life change events and other policy changes. She mentioned call center issues that are being addressed for the next open enrollment. She then described the process for renewals and automatic renewals, as well as issues that arose concerning eligibility determination, tax documents, and the small business marketplace.

Ms. Work discussed the goals and objectives for the exchange. Ms. Work addressed data security and personnel. She then discussed the core technology components used by Connect for Health Colorado, including the website, online marketplace, and the shared eligibility system., as well as external systems such as CBMS and insurance carrier systems. Ms. Work provided more detail on the shared eligibility system and improvements that are planned for this system. Representative McCann asked about the data warehousing system and how carriers are paid. Ms. Work explained how an individual's information from the data warehouse is shared with the Internal Revenue Service and subsidy payments are sent from the federal government to the insurance carrier.

Senator Roberts asked about retention rates for Connect for Health Colorado compared with exchanges in other states. Ms. Benshoof stated that this year's goal was a 70-percent retention rate and that they achieved 66 percent. She discussed the industry standard in Colorado and the lack of baseline data after only one year of operations. Next year's goal is 68 percent retention for the individual market and 80 percent for the small group market. She discussed differences in how states measure retention, which can explain some differences with other states. Representative Sias asked about real-time eligibility determination and what the predicted number for next year will be . Ms. Work explained how the CBMS system evaluates applications. Mr. Patterson elaborated on the issue of real-time eligibility determination. Ms. Work further discussed problematic cases that did not result in an immediate eligibility determination or could not be used by the exchange system for various reasons. Ms. Flores-Brennan added that the board allocated funding for customer service staff that can address these cases.

12:28 PM

Representative Ryden asked about the small group SHOP marketplace and vendor oversight. Ms. Benshoof explained that the current vendors used for the SHOP system are focused on the technology side and that they are moving toward a vendor selection that has more small group expertise.

Representative Primavera asked about computer-generated messages sent to consumers and whether they are understandable to members of the public. Ms. Work stated that they are trying to work on improving the letters, but that there are certain legal requirements for letters sent concerning Medicaid eligibility sent by the Department of Health Care Policy and Financing (HCPF). Ms. Work said that the exchanges mailing are simpler.

Senator Kefalas asked how they define "real-time eligibility" and Ms. Work explained the definition that they use. Ms. Work explained which customers go through the PEAK application and which only use the Connect for Health marketplace system. Ms. Work then discussed key changes to the shared eligibility system and stated that these costs are being shared with HCPF.

Senator Roberts thanked the panel for address the concerns raised by the committee and recognizing the challenges facing the exchange. Senator Roberts asked about people who owed taxes to the IRS through no fault of their own after using the exchange to receive an advanced premium tax credit and what Connect for Health Colorado's obligation to them. Ms. Benshoof stated that the exchange wants to educate consumers and has taken steps to let customers know that they have to update income and household information so as to avoid tax penalties from subsidies being too high. She explained that consumers can adjust their tax subsidy themselves online without a life change if they are concerned that the subsidy is too high due to increased income or other changes. Representative McCann asked about reimbursement from Medicaid for changes to the shared eligibility system. Mr. Patterson stated that they were able to leverage a 50/50 match for prior work serving Medicaid clients. Going forward, Mr. Patterson stated that they are in discussions about the match rate and other issues. Senator Martinez Humenik asked about whether consumer know they can call to make changes to income and if they are confused by the website. Ms. Work stated that they have tried to incorporate feedback from consumers and have made changes to simplify parts of the application process. Senator Martinez Humenik asked about non-English speakers and whether they have problems with the exchange website.