Mass. Health Connector website faces critical test in July

An assessment of the new software for the Massachusetts Health Connector website, set for early July, will provide the first read on whether the state is likely to succeed at running its own health insurance marketplace in 2015 or will default to the federal system.

Meanwhile, the state will extend until the end of this year the transitional programs that have enabled people to obtain coverage despite the Connector site’s failure to work properly since it was launched last October.

The Connector announced last month it would scrap the trouble-plagued software that was intended to bring the state’s system into compliance with the federal Affordable Care Act. Instead, the state is pursuing a “dual track,” working to adapt software used in other states, while preparing to join the federal Healthcare.gov insurance marketplace in case that effort fails.

The “critical checkpoint” with the US Centers for Medicare & Medicaid Services in July will start to clarify the most likely route. If state and federal officials conclude that the state-based website is progressing well, the Connector will continue on the dual track. If not, it will focus on preparing to join the federal marketplace for one year.

Maydad Cohen, special adviser to the governor, told the Connector’s board Thursday that the first version of the software, developed by the Virginia technology company hCentive, will be completed by June 30. Cohen has replaced Sarah Iselin, an insurance executive hired temporarily to oversee website repairs; Iselin returned to the private sector last month.

Jean Yang, the Connector’s executive director, said federal officials this week approved extending through December the temporary programs: Commonwealth Care — a subsidized-insurance program that was supposed to shut down last year because it did not match the requirements of the Care Act — and Medicaid coverage for people whose eligibility for subsidized insurance could not be determined because of the Connector site’s troubles. The programs were set to expire on June 30.

The temporary Medicaid program has enrolled 227,374 people whose eligibility could not be verified. Glen Shor, Connector board chairman and state secretary of administration and finance, estimated that 99 percent of those enrollees are in fact eligible for either subsidized insurance coverage or Medicaid.

He told the board that despite the inability to enroll people in the expected programs, the aggregate spending “closely matches” budget projections. Neither MassHealth (the state’s Medicaid program) nor the Connector will need to ask the Legislature for additional money to cover care, Shor said.

The Connector has enrolled 296,686 new members since December, mostly using paper forms and other workarounds.

While Connector officials expressed optimism about their progress with hCentive, preparations to join the federal marketplace are also moving along smoothly, Ashley Hague, deputy executive director, told the board. The only glitch with using Healthcare.gov is an inability, so far, to provide state subsidies along with federal subsidies, she said. The hCentive software is able to integrate the state subsidies.

The total cost of the “dual track” approach was estimated last month at $121 million. Since then, the Connector has identified $40 million in federal grants that could be “repurposed” to support this effort. It remains unclear what the total bill will be, nor how much of the cost will be borne by the federal government and how much by the state.

Lora Pellegrini, president of the Massachusetts Association of Health Plans, said that many of the people temporarily enrolled in Medicaid probably belong in private coverage, paying premiums. Additionally they are all in fee-for-service Medicaid, missing out on disease management programs that managed-care plans provide. “That’s why we think it’s important to get those folks into permanent coverage as soon as possible,” she said.

“Our plans need to very quickly have one path to pursue. . . . We were very committed to health care reform and we’re very committed to seeing this through, but obviously it’s not what we expected to be doing in 2014,” Pelligrini said.