It wasn’t exactly a trip to the woodshed, but state officials from MNsure and the departments of Human Services and Commerce were put on clear notice last week: This time around, the state’s insurance exchange had better work.
About 15 members of the Legislature’s MNsure Oversight Committee last Wednesday heard testimony from officials in the wake of a pair of unflattering reports from the Office of the Legislative Auditor — and on the eve of MNsure 2.0’s Nov. 15 rollout.
The auditor’s report on eligibility determination found that the state did not always ensure that the people who used MNsure were eligible for the benefits they received. In some cases, enrollees received coverage although they weren’t eligible for the programs, and other times, the state paid more because enrollees were put in the wrong program.
The audit looked at a sample of 193 people who enrolled in the programs between October 2013 and April 2014. It found that almost 17 percent were given incorrect information about the benefits they should receive.
The brains behind the exchange gathered before the committee to promise — almost — that it won’t happen again.
MNsure CEO Scott Leitz told the committee that he was “cautiously optimistic” that the enrollment period that started Saturday would go off without a hitch, but emphasized repeatedly that there was no way to guarantee perfection.
Leitz took over MNsure after the abrupt resignation of April Todd-Malmlov last December. An audit of the MNsure system last spring by Deloitte uncovered an inordinate amount of complexity and at least 10 “blocker” (or highest priority) defects in the site’s production environment.
Asked by Rep. Tara Mack, R-Apple Valley, whether the blockers identified by Deloitte had been fixed, Leitz said he believed so. Rep. Joe Atkins, DFL-Inver Grove Heights, the committee’s co-chair along with Sen. Tony Lourey, DFL-Kerrick, pressed Leitz for some assurance that the site would run seamlessly, but Leitz insisted that wasn’t possible.
“There’s no such thing as 100 percent when it comes to a large IT build-out with a deadline,” said Leitz, who testified along with MNsure Chair Brian Beutner. Leitz added that part of the problem with the initial debut of MNsure in October 2013 was that the staff had to rely on “hot fixes” — on-the-fly code patches — to repair problems after the site went live.
The closest Leitz would come to a promise was to say, “We’ve added plan data functionality and we know the core system will be dramatically improved.” He went on to say that more people will qualify for financial assistance from MNsure as premium rates rise and that the site’s capacity for comparison shopping by enrollees will be improved – allowing users to compare providers within their geographical region, for instance.
Peter Brickwedde, the Commerce Department’s director of Government Affairs, took some heat over how his office asked PreferredOne to lower the rates of the policies it provided to MNsure enrollees, leading to a scenario in which the insurer couldn’t make enough in premiums to cover its costs — and eventually prompted PreferredOne to bow out of the program.
“You need to be careful about pretending there was no pressure (on insurers),” said Sen. Michelle Benson, R-Ham Lake. “I think on their end, the message was, ‘You put in the numbers we want you to put in.’”
Benson also pointed out that MNsure eventually approved rate structures that led to $1.30 in payouts for every dollar in premiums collected. “Your math was wrong,” she said.
Sen. Kathy Sheran, DFL-Mankato, disagreed, saying that protecting consumers from high premium rates should take priority. “The notion that insurance companies are helpless is not a posture I share,” she said.
Brickwedde noted that Commerce doesn’t set rates, but rather reviews products available to the insurance exchange.
The most organized rebuttal to the legislative auditor’s findings came from Human Services, which printed a point-by-point sheet that it made available at the meeting detailing past MNsure glitches that have either been fixed or are in the process of being fixed.
Among the steps DHS is taking are correcting system functions that previously allowed duplicate accounts and recovering payments that were mistakenly sent twice.
DHS Commissioner Lucinda Jesson told the committee that the burden placed on counties by continuing to process paper MNsure applications will be offset by a 75 percent match from Medicaid to hire more county workers.
Pushed by Mack on the lack of verification measures in place to screen MNsure applicants, Jesson said her department relied on the Federal Data Services Hub to verify applicants, and in September of this year started matching that data against another data set to make sure applicants weren’t already on a public insurance program in another state.
Jesson also expressed guarded optimism of the new MNsure system. “We’re making progress and we have a ways to go,” she said. “The system will be better than it was a year ago.”
The last word went to the legislative auditor’s office, which oversaw the audit of MNsure’s internal controls and compliance. Auditor James Nobles said another report from his office evaluating the implementation of MNsure will be released in February.
Nobles described MNsure as “one of the most complex, important and expensive implementation of a policy as Minnesota has ever done,” and allowed that there was still a lot of work ahead to make MNsure run smoothly.
“We have to remember that there are people affected by all the defects and problems,” he said. “When eligibility is determined incorrectly, that affects families.”