[G]ov. Peter Shumlin’s health care reform team told the House Health Care Committee on Thursday about bigger challenges with Vermont Health Connect than was previously reported.
Lawrence Miller, the chief of health care reform, said the number of changes to customer accounts waiting to be handled by the state’s health insurance exchange peaked at 5,700 on Jan. 25. The number is higher than the 4,000 that VTDigger reported Jan. 24 from Blue Cross Blue Shield of Vermont and the 3,000 that Vermont Public Radio reported a few days earlier. In a Jan. 21 interview, Miller was unable to give VTDigger a number of backlogged cases.
Miller characterized the 5,700 pending changes of circumstance as an “inventory,” instead of a “backlog,” which has been the term of choice for the governor, lawmakers and other stakeholders over the past year to describe the problem.
Additionally, the administration reported Thursday that the third-party biller that collects payments from Vermont Health Connect customers to pass along to insurers was holding $5.9 million on Dec. 31.
Money builds up in the account for various reasons. If the vendor, Benaissance, does not receive the full payment of a customer’s account balance, it doesn’t send the money to the insurance company. If the vendor receives an overpayment, it holds onto the extra money.
“We don’t forward partial payments,” said Cassandra Gekas, the director of operations for Vermont Health Connect. “It will take a (new software) development to change that.”
Miller said Thursday about $680,000 in the account represents subsidies for low-income customers that were not paid to insurers because the customers sent partial payments. He said the state would find out where the remaining $5.2 million should go during the next account reconciliation.
In April, VTDigger reported that Benaissance was holding about $5 million in customer premiums and had a change of circumstance backlog of nearly 12,000 cases. Both the account balance and the backlog change almost daily.
By Oct. 1, the governor said the backlog of changes had dropped to only 100 to 200 complicated cases, but it mushroomed again.
The Shumlin administration provided the new numbers at the request of the House Health Care Committee, which has decided to bring Shumlin’s health care reform team in to testify at an indefinite number of weekly hearings to determine whether the state should move to the federal exchange.
Blue Cross Blue Shield of Vermont and Vermont Legal Aid have both requested that the state commission an independent review of Vermont Health Connect to determine whether there are problems with the technical structure of the exchange. Miller said Jan. 21 that an independent review is not necessary, and he has declined to give further interviews.
The administration reported in November that 32,761 people were enrolled in commercial health insurance through Vermont Health Connect. At the Thursday hearing, the administration said the number is fewer than 30,000. Blue Cross continues to insure about 90 percent of those people, and MVP Health Care, a New York-based company, insures the rest.
Over the last several months, the administration has been moving about 143,000 Medicaid patients over to the exchange.
The state and the two insurers still cannot perform automatic account reconciliations, frustrating many exchange users whose bills don’t match what they owe — and requiring workers to do it manually.
Customers also continue to say they are routinely dropped from their health insurance policies because of technical problems. Gekas, the director of operations for Vermont Health Connect, said part of the problem is that billing processes are confusing.
Gekas said people who pay late automatically enter into a grace period, and they might not know they’re in a grace period. She said many people also send partial payments, which don’t get forwarded.
Miller said he sometimes sees cases where the postmark on a customer’s check is well after the due date. “They need to pay their bill,” he said. “I don’t mean there aren’t errors. I’m not saying that. But there are other issues.”
With regard to commercial insurance policies, Miller said the state anticipated being able to use an automated renewal process for more than 90 percent of cases during this year’s open enrollment period, which ended Sunday. The exchange ended up being able to automatically renew about 80 percent of health insurance cases, he said.
Miller said the bumps during open enrollment happened when his team had to turn off the online change of circumstance function because a piece of software code that the vendor Exeter Group gave the state was not ready to be deployed by Dec. 31. The company went out of business “literally overnight” in October, his team said.
On Jan. 21, while the change of circumstance function was turned off, Miller said it would take about a month to clear the backlog once the state got the underlying code to work the way it wanted.
The governor’s office said Wednesday the function had been deployed successfully the previous week and the exchange was again processing changes of circumstance.
Miller said many of the former Exeter Group staffers are working for a different subcontractor now. But he said, “I don’t recommend having your vendor go out of business and leaving you with source code management.”
With regard to Medicaid, Miller said the state has begun to contact 10,000 households a month that have at least one person enrolled in a form of Medicaid in order to renew and revise their coverage. He said it would be a long time before the state has a statistically significant estimate of how many people were on Medicaid who shouldn’t have been.
Gekas said it’s the state’s third attempt to renew income information for Medicaid households. “We’ve gone through two other pilot programs,” she said.
She said the state is mailing packages of information to people who are on Medicaid.
The state is trying to give people enough information to comply with federal laws, but also adding explainer information to help them understand the jargon, she said. But if the state can’t get a high level of response to the packets, she said, “we’ll need to get creative again.”
Editor’s note: This story was updated at 11:55 a.m. Feb. 2 to clarify where information about the number of backlogged cases came from.
