Vermont to apply for extension of federal ACA implementation grants

Vermont will apply for an extension of its roughly $100 million in remaining federal grants for implementing the Affordable Care Act, state officials confirmed Monday.

Vermont has spent more than $72 million thus far, and state officials have indicated they believe it will take the full $171 million earmark to complete the project.

Lawrence Miller, chief of health care reform testified before the Joint Fiscal Committee on July 24, 2014, with Stephanie Beck, the person responsible for the overhaul of Human Services' IT systems. Photo by Hilary Niles/VTDigger

Lawrence Miller, chief of health care reform testified before the Joint Fiscal Committee on July 24, 2014, with Stephanie Beck, the person responsible for the overhaul of Human Services’ IT systems. Photo by Hilary Niles/VTDigger

Four of the 15 states building their own exchanges have already applied for extensions from the federal Centers for Medicare and Medicaid Services and several others told Politico they intend to apply.

Lawrence Miller, chief of health care reform, said “So long as states are making a good effort and are undertaking a responsible path to finish the work, (CMS) is going to continue to be supportive.”

The extensions would not increase the money available for exchanges, and there are no details on how long they could last. However, so-called “no-cost” extensions are common practice with federal grants, according to a CMS spokeswoman.

An extension would allow the state to continue using that money past the Dec. 31 deadline to build core components of its exchange – most notably completing the Vermont Health Connect website. The grants are not to be used to cover operating costs.

But it’s not that simple, Miller said.

If an exchange lacks a basic function, such as allowing users to make changes to their applications – which Vermont’s does – then costs that would otherwise be considered operating costs, such as running a customer support call center, can be partially billed as development costs, according to the guidance the state has gotten from CMS, Miller said.

An extension is “necessary,” he added, and without one, Vermont would likely have to come up with additional money to operate the call center and prop up functions that are eventually expected to be automated.

The administration is not anticipating needing additional state money for Vermont Health Connect in fiscal year 2016 or in the FY 2015 budget adjustment, Miller said.

There are contingencies for using personnel to process changes and renewals through next year, Miller said. The state has already said it would continue to allow small businesses to obtain insurance through the exchange directly through the insurance carriers in the next enrollment period.

“Knowing what we know now, nobody feels comfortable assuming (the remaining work) will get done,” before the end of open enrollment in February 2015, he said, though the state will continue that work.

Under pressure to scrap VHC?

Small states with fewer customers in their exchanges could have trouble covering the IT bills necessary to run a state-based exchange, according to Politico’s report.

Jon Kingsdale, with the Wakely Consulting Group, told Politico that he anticipated pressure on small states to adopt the federal exchange or join “some kind of multistate operation,” but that “state’s with aggressive health care reform agendas are likely to continue to push for local control.”

Kingsdale was not comfortable doing an interview with VTDigger without permission from state officials, as he is currently consulting for the state on health care. State officials did not respond to an email request to interview Kingsdale.

But Vermont is a small state; its exchange has only 67,000 commercial customers, the rest of the 103,000 users are on Medicaid. Of the 67,000 commercial plans people bought, less than half, or 33,000, were purchased using the website – carriers having enrolled the rest.

For example, Washington state, with roughly 12 times Vermont’s population, has 164,000 commercial customers and enrolled close to 600,000 people total in it’s exchange.

Vermont’s intention to provide universal coverage for residents through a single-payer program qualifies its reform agenda as aggressive.

Correction: The fiscal years referred to in which  additional state money for VHC were incorrect in earlier versions of this story. The correct dates are FY16 and the FY15  budget adjustment. 

Morgan True

Comments

  1. Jim Christiansen :

    So Vermont Health Connect won’t be ready before the end of open enrollment in February 2015. Again, I’m shocked.

    Just for kicks, here’s a link for the ever classy Mark Larson lying through his teeth and belittling critics before the first missed deadline, Oct 1, 2013.

    http://www.wcax.com/story/23567331/vt-health-connect-kicks-off-tuesday

    Mr. Shumlin, how much more of this, how many more lies, missed deadlines, millions of wasted taxpayer dollars are Vermonters going to have to endure before your mandate to purchase insurance through an exchange that doesn’t work is reversed? Governor??? Is there anyone in that suit???

    • Wendy wilton :

      Jim, Mr. Shumlin is busy raising money for the legal defense fund for GMO labeling. That seems to be more important than ensuring Vermonters forced to use VHC have access to health care.
      Now, what will be interesting to see is if VHC will work to provide the platform for single payer. Will single payer require an enrollment function in order for the state to claw in the federal subsidies? What will the state say to the Feds and our congressional delegation about using $171 million in US taxpayer funds that was essentially wasted if it does not work?

  2. rosemarie jackowski :

    This is a comment just made by a Mexican on CommonDreams. It gives a glimpse into their health care south of the border. Are Mexicans really so much smarter than we are? How come they figured it out, and we can’t?

    “National Healthcare (Seguro Popular) full coverage. Average premium $20 year OR IMSS/Mexico’s Social Security Cadillac plan $34.00 month, full coverage medical/dental/eyecare/prescription meds.
    Senior discounts, 50% off driver’s licenses, property tax, public transportation, concerts, special events etc.”

    • Jon Corrigan :

      With such great health care, why are there millions here illegally and why do millions more want out?

  3. Bill Dunnington :

    It’s a very good idea to ask for an extension – all indications are we won’t be ready.

    Having just re-read all the recent reports and posts about this, it looks (to me) like this whole health care initiative is blowing up:
    – we don’t know exactly what is is or how to fund its development and ongoing operations,
    -the technology isn’t being fixed well enough fast enough, and can’t guess at the use cases and processes that need to be enabled,
    -AHS needs a transformation, not just new systems, (Can’t “tech” its way to the future.)
    -the business case, and concept of operation for single payer are not clear enough for solid financial modelling,
    – the RFPs are calling for an out-of-date, last-century approach and skill set, (expensive waterfall vs agile, open sourcing, stacks, cloud, etc)
    – the patterns of management need to foot more to proven program management, less to management by press conference,
    -we need some apolitical leadership. None of the people involved (all good folks, caring, well intentioned) have the experience to lead and manage the scope and scale of this initiative.

    We all have our opinions – but nobody has put the whole problem on the table. It’s is now a very big problem with much at stake.

    It’s an even better idea to get on a more constructive path…. think very hard, but not very long about changes that will raise the odds of success.

    We need a constructive way to put the brakes on, call time out, ask for fresh thinking and competent help and hold a “no-fault” top to bottm review – then make the changes with fact-based, reality-tempered judgement.

    And we need to be prepared to ask for help, and be willing to back off decisions and commitments that may no longer be real enough to be betting this amount of money on – not to mention the health care of Vermonters.

    Put the brakes on. Call time. One month all hands on deck review. Top to bottom. All decisions and choices on the table. No fault approach. Facts and data first. Help from an array of competent resources. Invite Accenture (the replacement for CGI at the Federal level) to participate.) No sacred cows. Like a big time GE workout, aimed at a health care hackathon.

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