One year after a troubled launch that led to the firing of private contractor Xerox, Nevada’s retooled health insurance exchange is entering its second enrollment period a little bit older and a little bit wiser.
Open enrollment starts Nov. 15 and runs through Feb. 15 for people looking to sign up for insurance through Nevada Health Link. The state stressed that there is no rollover from the previous period so everyone has to re-enroll again, including those who signed up last year.
The question now is whether Nevada Health Link can leverage the hard lessons it learned to prevent the problems that dogged consumers the first time around, including sign-up difficulties, uncredited payments and long hold times on the phone.
One thing for certain is that this enrollment period’s health insurance exchange is a different beast. In place of Xerox, Nevada is placing its eggs in the federal government basket by using Healthcare.gov for enrollment.
It’s a big change for Gov. Brian Sandoval, who initially resisted switching to the federal system for the enrollment process. In the lead up to the launch of Nevada’s health insurance exchange, Sandoval stressed that he preferred to have the state in charge of as many facets of its program as possible.
Even as problems started to mount with Xerox’s platform, the state was still hesitant to make a quick switch due to logistics issues and Healthcare.gov’s own documented woes.
“It’s not plug and play,” Sandoval said at the time. “Frankly, although this exchange is not performing to my expectations, my understanding is that most if not all of the federally run exchanges are doing worse.”
Ultimately, Nevada pulled the plug on the Xerox contract, citing unsatisfactory results from the company’s attempt to fix its service. Although the state still oversees other parts of the exchange, Nevada Health Link will use a federal platform for enrollment.
NEVADA’S PLAN B
Enrollment woes were blamed as a key reason why the state exchange only enrolled 36,827 people in qualified health plans despite more than 300,000 being eligible. The lone bright spot was the Medicaid expansion, which generated nearly 160,000 applications.
The nixing of the deal with Xerox led to the use of the federal platform for enrollment this year.
It’s a hybrid approach known as a “supported state-based marketplace” that still allows Nevada to be classified as a state-run exchange and continue to certify plans while also determining coverage eligibility. Oregon, which had even worse problems with enrollment than Nevada during last year’s launch, is the only other state to use a similar system.
Although the hybrid system will be in place in Nevada this year and likely next year as well, it doesn’t mean the state is ruling out the launch of its own enrollment system in the future. Nevada still has access to the remaining funding it received from the federal government for setting up its own exchange. The state received $83.7 million in federal funding from the Affordable Care Act, also known as Obamacare.
“I don’t think anybody ever said that (using federal enrollment) is a final solution,” said Bruce Gilbert, executive director of Nevada Health Link. “Given what we experienced last year, the idea was to do something that works right now and then review and potentially revise it in the future.”
To its credit, Healthcare.gov has undergone significant improvement since its own bungled launch, Gilbert said. Gilbert described the federal enrollment platform as “more robust” and featuring more options than the Xerox system used last year.
“Another advantage in using a federal enrollment platform is that billing and premium collection is now handled by the insurance carriers rather than the exchange,” Gilbert added.
BOOTS ON THE GROUND
Having insurance carriers take care of billing should help resolve one of the bigger headaches with the health insurance exchange from last year: The ability to enroll cleanly while also ensuring that payments are received and tracked appropriately, Gilbert said.
Addressing the woes of the previous enrollment period was a common theme for the state as it explained the new features of the exchange. A new personal assistant tool allows consumers to look up information such as insurance brokers by zip code, for example. A pre-screener tool also determines eligibility for either a qualified health plan or Medicaid and automatically directs consumers to the appropriate program.
Even Healthcare.gov simplified its sign-up process by trimming it from a whopping 70 pages that required validation for each step to just 16 pages, requiring validation only after all information is entered. Switching to federal enrollment also gives Nevadans access to a more sufficiently staffed call center that runs 24/7 with the exception of major holidays.
“A lot of those frustrations (from last year) should go away,” Gilbert said.
At the same time, Gilbert stopped short of predicting a flawless launch this enrollment period. To address any potential issues with the online system, Reno and Las Vegas also will each have a brick-and-mortar location for walk-ins from Nov. 15 to Feb. 15 that will be open seven days a week. Reno’s “enrollment store” will be located at 3937 S. McCarran Blvd., and operate from 10 a.m. to 7 p.m. Hours also will be extended from 9 a.m. to 9 p.m. on the 15th of each month.
“There are going to be hiccups, bumps and problems so we’re doing everything we can to ensure that consumers get as much help as possible,” Gilbert said. “We have boots on the ground, we’re working with our partners and we have a direct link to (the Centers for Medicare and Medicaid Services) should an issue arise.”
Date: November 12, 2014