A legislative leader said Wednesday that ongoing problems with Vermont Health Connect have reached crisis levels in communities across Vermont.
Rep. Mike Fisher, chairman of the House Health Care Committee, said myriad issues affecting people’s health care coverage has led to frustration and uncertainty in the lives of thousands of Vermonters, a sentiment echoed by advocates and providers.
“It’s just untenable to continue to be in this situation,” said Fisher, a Lincoln Democrat facing a re-election challenge in November.
If the situation hasn’t improved when lawmakers return in January “everything is on the table” to find a legislative fix for the issues that plague the state’s online health insurance market, he said.
Thousands of people have problems with their coverage – those with commercial plans and those on Medicaid – that can take days or weeks to resolve, creating uncertainty for many when they go to the doctor or try to fill a prescription.
In addition, it was revealed that an estimated 22,000 Medicaid beneficiaries have lost their coverage in the past three months because they were unable to, or have not tried to, complete their annual reviews on the Vermont Health Connect website.
State officials announced a federally approved remedy to provide retroactive coverage to those affected, but providers say those people still show up as not covered when they obtain services.
“We are getting more and more calls from really irate people,” said Trinka Kerr, director of Vermont Legal Aid’s Office of the Health Care Advocate. Many of those calls are coming from “people that were initially really excited about their coverage,” she said.
The overall picture presented to lawmakers, who described the update as “disheartening,” was of a well-intentioned program that’s still in disarray. Despite continued work on the site, progress over the summer has been minimal.
Health Care Reform Chief Lawrence Miller said he’s not satisfied with the pace or quality of the work being done by the state and its contractors.
“There’s been a lot of work and no evident progress for consumers,” Miller said. “It’s nothing that needs to be scrapped, but it’s definitely something that needs some work and remediation.”
The primary problem is the same as it has been since the beginning of the year — users can’t correct mistakes they made putting information into the website and they can’t use the website to make changes in their coverage to reflect qualifying events in their lives.
Those issues must be handled through the Vermont Health Connect call center, which with the help of a recently hired contractor, has created a process to “elevate” cases in which a mistake or change is preventing someone from accessing care or is holding a medical claim in limbo.
Providers and navigators, who help people enroll and solve issues with their coverage, said that process still requires hours on the phone. Issues that don’t meet the fast-track criteria take days or weeks to be resolved. Access to care fixes that are not initiated early in the day often get pushed to the next day.
There is a backlog of more than 14,000 corrections and changes that need to be made in people’s coverage or personal information in order to ensure they’re covered.
That number has grown despite additional contractors working to reduce it. When the backlog was initially reported in the spring, there were 10,000 pending changes. Figures from the state show it has resolved close to 7,000 in that time.
Many of those changes could affect people’s eligibility for Medicaid or subsidies they’re currently using to pay for health services. That could exacerbate the poorly understood reconciliation process the users will have to complete at tax time.
The state is still investigating why only an estimated 45 percent of people who needed to renew their Medicaid coverage in the past three months have actually done so, Miller said. The typical rate is closer to 90 percent.
The people affected were on Medicaid before the Affordable Care Act increased the program’s income threshold and many are close to or below the federal poverty line. Many are children and families.
Medicaid eligibility is reviewed annually, a process that was previously done through a paper form mailed to beneficiaries. Now people must go onto the Vermont Health Connect website to renew their coverage.
The state took a hiatus from doing reviews last year to allow the Vermont Health Connect website time to improve. When it resumed reviews in April, state workers became concerned by the low return rate.
Providers and navigators say that for months people who think Medicaid covers them aren’t showing up as covered when they go to fill prescriptions or visit the doctor.
Instead of the paper form that people are accustomed to, beneficiaries received notices from the state asking them to log on to Vermont Health Connect to confirm their eligibility. People can also call the call center or work with a navigator to complete their review.
“It doesn’t look like noticing was done correctly,” Miller said, suggesting the notices sent to beneficiaries might not have had the proper information.
“They’re still trying to track that down,” he said.
The state apparently had not anticipated that low-income Medicaid beneficiaries might have trouble using a new Web tool to renew coverage, that they might not seek help from navigators or that they might not recognize the notice as a substitute for their renewal form.
Some beneficiaries who did try to use the Vermont Health Connect website to renew may have ended up in the “change of circumstance bucket,” if they made a mistake entering their information, Miller said.
A mistake could be something as small as using an abbreviation in an address, and must be fixed by calling the busy Vermont Health Connect call center.
Those people’s changes are now in a queue with the thousands of other changes being requested.
The federal Centers for Medicare and Medicaid Services gave Vermont permission to reinstate people who lost coverage for that reason. But if people think they’re not covered, they might not seek services, advocates say.
The state is assuring beneficiaries and providers that services will be covered retroactively and is asking that denied claims be held and resubmitted after Aug. 1 to give the state time to try to resolve the issue.
Updated 10:36 a.m. Thursday: State officials clarified the number of Medicaid beneficiaries who lost coverage because they did not or were unable to complete their annual information update.