MNsure Struggles To Keep Up With ‘Life Event’ Changes

Sept. 02--When a new baby arrives, parents want the infant quickly added to their health insurance.

But for 78 new moms in Dakota County this year, the process bogged down for months because of a change to Minnesota's new MNsure health insurance exchange.

For five months, county workers said they couldn't use the new system to add babies to their mom's coverage in Medical Assistance, the state's primary safety net health insurance program.

Then, when state officials unveiled in June a work-around process for adding babies, county workers found the process usually took an hour or more per baby. Before MNsure, the job usually took about five minutes.

"It really is taking a lot of time," said Marti Fischbach, director of employment and economic assistance in Dakota County.

The trouble with babies points to a broader problem with the MNsure system. It remains a slow and difficult process for state, county and health exchange workers to record "life events" for people who have obtained coverage through the new online marketplace for insurance.

Moms need coverage for new babies. Husbands and wives sometimes need to add a spouse to their policy. People move, so they need to provide notice of a new address. Income can change in ways that impact eligibility for government programs.

The MNsure system needs to be able to record all of these life events and others. But the labor-intensive process for doing so has led to a backlog.

Nearly 25,000 life event changes wait to be recorded for people in the Minnesota-Care insurance program, and nearly 3,800 changes must be processed for those with commercial coverage sold through MNsure. Officials said only a few of these backlog cases are thought to involve babies.

In emergency situations, MNsure and state officials have been getting life events into the system so that babies and adults have coverage for the care they need, said Chuck Johnson of the state Department of Human Services. Still, the situation is "unacceptable in terms of the service that we're able to provide consumers," said Johnson, whose department runs the state's public health insurance programs.

"I think we under-appreciated the amount of work it was going to take to get life changes up and running," said Katie Burns, the chief operating officer at MNsure. "I think the hope was we would be able to do this earlier in 2014, and we're still not there."

'UNACCEPTABLE'

Minnesota launched the MNsure health exchange last year to implement the federal Affordable Care Act, which requires almost all Americans to have coverage or pay a tax penalty.

People use MNsure to see if they qualify for Medical Assistance or MinnesotaCare, which are public health insurance programs. They also can use the exchange to buy commercial health insurance policies.

As of August, more than 246,000 people had used MNsure to enroll in public health insurance programs, while 53,000 had used the exchange to buy private insurance.

Delays with adding a baby to coverage could mean trouble for families when taking an infant to the doctor for care. There's a fear some could go without needed treatment.

"We will continue to see the child until they get put on the insurance, but it definitely causes added stress for the family," said Connie Walsh, lead patient advocate at United Family Medicine, a clinic in St. Paul.

"If they need medication, we don't have a pharmacy here. ... People don't know it's a crisis until they try to fill that prescription for an expensive antibiotic."

State officials say they aren't aware of any cases where babies have gone without needed care because of a delay in adding a baby to coverage. But they aren't happy about the situation, either.

"This is unacceptable, and we would not want any family to have to wait to add a newborn, or to have any life event processed," said Jenni Bowring-McDonough, a MNsure spokeswoman. "When it's brought to our attention, we absolutely try to process that as quickly as possible."

Some moms have publicized their struggles this summer by posting concerns on the Facebook social media website. One said it took more than two months before she could get her baby added to her commercial policy.

Walsh of United Family Medicine said she's seen moms wait two months to get babies added to Medical Assistance coverage, too. Bowring-McDonough said MNsure has made improvements "so we are processing these cases more quickly."

In late July, the health exchange hired Optum, a division of Minnetonka-based UnitedHealth Group, to review the overall situation with life events and help make calls to consumers. For work through the end of September, Optum is being paid $498,000.

To make more progress, MNsure is hiring an additional 15 workers who will help tackle a backlog of nearly 3,800 life event changes that need to be made. About 380 of the changes involve adding someone to coverage.

"We know that many of those are not a newborn case," Burns said. "Some are."

Once a newborn is added to the insurance policy, coverage is retroactive to birth, said Bowring-McDonough. Many changes in the life events backlog, she added, involve income changes, which is important for determining if someone should get government assistance with health insurance costs.

TACKLING THE BACKLOG

The state's legislative auditor expects to release a report in October on MNsure's ability to accurately determine eligibility for Medical Assistance and MinnesotaCare.

At the state's Minnesota-Care program, the backlog of 25,000 life events that need to be processed doesn't include any babies, said Johnson of the Department of Human Services.

Enrollment in Medical Assistance is handled primarily by counties in Minnesota, and those workers generally have been keeping up with add-a-baby cases, Johnson said. "The MNsure process has added a significant amount of work for county staff," wrote Tina Curry of Ramsey County in an email.

"It's all the clicks and all the information that you have to put in -- you basically have to put a new application in for the newborn," said Jackie Poidinger, program manager for Hennepin County.

Adding a baby in the new system is difficult, but the real concern is the future, said Jerry Vitzthum, director of economic assistance for Anoka County. In the coming weeks, the state will be rolling out instructions for how county workers can change addresses and add adults to Medical Assistance cases.

"If everything works this way," Vitzthum said, "we'll have to hire a lot more staff to get things done."

The struggles with life events come as the state is trying to convert about 800,000 current Medical Assistance and MinnesotaCare recipients to the new MNsure system. The transition is key for MNsure to realize its goal of covering 1.3 million Minnesotans by 2016, but state officials in late August decided to delay the process once again due in part to the concerns from counties.

"We're extending out the timeline," said Johnson of the Department of Human Services. "One (reason) is life events, and that we're not as far along in that as we'd like to be."

Improving the process of handling life events was a top priority for MNsure set this summer by Deloitte, the state's health exchange consultant. Another top priority was making sure MNsure has a process so that people can renew commercial policies during an open enrollment period that begins Nov. 15.

To run those commercial renewals, MNsure needs to clear out the backlog of life event cases, said Bowring-McDonough, the MNsure spokeswoman.

It's no consolation to the state or consumers, Johnson said, but Minnesota apparently isn't alone in grappling with life events.

"Every state is struggling with life events -- it's a common problem," he said. "It's one of those things that wasn't necessary to get the (exchange) up and running on Oct. 1. ... Now, everyone is struggling to figure out how to get that functionality working."

Christopher Snowbeck can be reached at 651-228-5479. Follow him at twitter.com/chrissnowbeck.

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