With the continuing issues with the Health Connector/MassHealth enrollment website, we get asked the following questions constantly:
The old web site worked just fine. Why did they need to build a new one? Why can’t they just go back to the old one?
It’s a fair question. It’s also being asked in a more accusatory manner by some political candidates, who are claiming that we should have asked for a “waiver” from the whole ACA and just kept our old system.
What most people who ask this question don’t realize is that the Connctor and MassHealth are trying to build more than just a website. The web interface is just the visible tip. Underneath is a whole new processing system for health program applications, eligibility and enrollment.
So, here’s part of the answer, based on what we know:
1. Until now, there was no enrollment website for most people. The Connector’s web site only allowed people seeking unsubsidized coverage to fill out an online form to enroll and select a health plan. That was for just around 40,000 people out of the over 250,000 people covered by the Connector. For everyone else, there was no public enrollment website.
To enroll in subsidized coverage, one had to go to a community health center, hospital, or a few community groups that were authorized to use the state’s “Virtual Gateway.” It was not open to the general public. We’ve been told that once, by accident, it was open for the general public for a few hours on a weekend. A number of people filled out applications while they could, and all of the applications were filled out incorrectly and had to be redone. That’s why the state only allowed trained people to fill out the form.
The new system will allow the general public to set up an account, fill out their own forms, and submit it themselves.
2. The old “Virtual Gateway” form did not process verifications. If you had a hospital worker fill out the form for you, you still had to fax in separately the income, residency and other verifications required for state programs. Then state workers had to manually associate the faxed-in documents with the form transmitted by the Gateway.
The new system will perform these functions automatically, in the background and in real time, by checking information already known to the state or federal government. For example, the system will check your wages with the Department of Revenue to see what your income is. Only if there’s a substantial discrepancy will the enrollee have to submit verifications.
3. The old system that determined eligibility was antiquated and difficult to update and maintain. Decisions took a long time to process. Under the old system used to process Connector and MassHealth applications, the determination of which program an applicant was eligible for was made by a system called “MA-21.” This 1980s era mainframe-style system was slow and very difficult to update. Changes in eligibility rules required lengthy, complex programming changes. The system produced awful form letter notices that were locked into a format that made it hard for people to understand. Decisions often took weeks.
The new system is designed to make instant real-time eligibility decisions. It will be easier to upgrade as program needs change. It also will be a platform for applications for other programs beyond health care.
Our HelpLine staff’s full-time job is enrolling people into coverage, so the current dysfunctional system makes us frustrated and furious at time (but note: the past few days we have had reports of substantial improvements in the system, with some people successfully applying, being determined eligible, and enrolling at one sitting). But the old system wasn’t so wonderful either.
We have two goals. First, everyone eligible for insurance must have a temporary solution, even if it means creatively working around some rules while the systems work is in progress. Then second, if we can get to a system that meets the goals outlined by the state, we will have made enormous strides to building a responsive, modern eligibility system that should last for a long time.
We’re looking forward to Thursday’s Connector Board meeting, just announced today, where we hope more progress can be made on system improvements.