For thousands of users, promise of MNsure is always ‘pending’

Jan. 31--Cindy Kennedy let go of her health insurance last year based on the promise of subsidized coverage through MNsure, the state's new health insurance exchange.

She applied in October, but by the fourth week in January, the MNsure system continued to list her application as "Pending."

"I'm uninsured for the first time since 1992," Kennedy wrote in an email to the Pioneer Press. Following one attempt to resolve the problem, "I cried for an hour in frustration."

It took an intervention last week by state workers, but Kennedy now has health insurance through the state's MinnesotaCare program.

But her confusion and frustration speak to the experience of others as the total number of pending applications in the MNsure system continues to increase.

Just because an application is pending doesn't necessarily mean an applicant doesn't have coverage, or won't receive retroactive coverage in the future, state officials say. Even so, the situation worries advocates for people who are trying to obtain insurance through the new system.

"My fear is that some people are not going to be successful in getting the coverage, because they don't know they need to do something more or they don't know how to do what they're being asked to do," said Ralonda Mason, an attorney with St. Cloud Area Legal Services. "Clearly, the system is struggling."

Minnesota launched the MNsure health exchange in 2013 to implement the federal Affordable Care Act, which requires almost all Americans to have coverage or pay a tax penalty.

People don't have to use the health exchange, but it's the only way for individuals to buy a commercial insurance policy with the help of a federal tax credit. The system also helps determine whether someone qualifies for MinnesotaCare or Medical Assistance, which is the state's name for the Medicaid health insurance program.

By mid-January, more than 80,000 people had successfully obtained public or private health insurance coverage through MNsure. But as enrollment totals have grown, so has the number of pending applications.

At the end of December, more than 17,000 people were connected to pending applications within the MNsure system. By Jan. 24, the number had grown to 29,994, said John Schadl, a spokesman for MNsure.

"People might have some frustration or confusion because there are several definitions of pending," said Rebecca Lozano, a health insurance navigator with Portico Healthnet in St. Paul. "It doesn't necessarily mean there are that many people stuck in the system. I would assume that the vast majority of those folks just need to submit the extra verifications."

SOFTWARE CONCERNS

Applications go into the pending file for a number of reasons, state officials say, and can broadly be categorized in two ways -- those connected with MNsure software issues and those involving eligibility verifications.

For years prior to MNsure, verifying eligibilty for government assistance could be a slow, confusing and frustrating process for consumers, Lozano said. As a result of the federal law, more people have access to government assistance, she said, so many could be experiencing those frustrations for the first time.

Navigators and state workers should be able to help make sure people get care while verifications are being worked out, Lozano said. When applications are pending due to problems with the MNsure website, navigators can help identify problems and get state officials involved.

"A lot of the issues and errors that people are experiencing could have been avoided or at least explained if people had help from someone," Lozano said, adding that fewer applications now seem to be pending for software reasons.

One of those software glitches involves families where children are thought to qualify for the Medicaid program, but parents don't. When more information is needed to verify that children qualify, coverage applications for the parents are wrongly being placed in a pending status, state officials say.The scenario was highlighted by Gov. Mark Dayton in a December letter to officials with IBM, which is one of four primary software vendors for MNsure.

"For people eligible for MinnesotaCare or (tax credits), the regulations require us to not delay eligibility," Dayton wrote. "Just because someone else on the application may be eligible for Medicaid does not allow us to ignore that regulation."

The backlog in pending applications has a lot to do with problems in software from IBM's Curam division, said Schadl, the MNsure spokesman. Last fall, it was flaws in the Curam software, he said, that forced the state to manually process 30,000 applications.

The work "overwhelmed MNsure's ability to respond and began a cascading series of events that led to significant backlogs in clearing pending cases, processing paper applications and responding to contact center inquiries in a timely manner," Schadl said in a statement.

"IBM/Curam has implemented fixes and identified workarounds that have addressed the problems and significantly improved the accuracy and reliability of its software...," Schadl said. "However, the delay in processing other cases that was caused by the difficulty with IBM/Curam software has led to additional backlogs."

But Mary Welder, a spokeswoman for IBM, countered that the Curam software actually has helped reduce the backlog of pending applications in Minnesota. The system is now successfully processing 99 percent of all applications, she added, noting that nearly 129,000 applications have been initiated.

"The success of any complex information technology implementation depends on all parties fulfilling their responsibilities," Welder said in a prepared statement. "MNsure has failed to appropriately account for many items that have been addressed and delivered by IBM Curam, but not implemented by MNsure."

"IBM has reduced the backlog from over 18,000 cases to 829 as of today," Welder said Thursday. "The facts simply do not support the assertions by MNsure."

'WE'RE ALL STRUGGLING THROUGH THIS'

Software concerns are just one reason for pending applications. Some people have pending applications until they submit information, although that doesn't necessarily mean people don't have coverage, state officials say.

MNsure users with a pending application for MinnesotaCare are presumed eligible for the program, and therefore have coverage, said Jeremy Drucker, a spokesman for the state Department of Human Services. Similarly, people with pending MNsure applications for federal tax credits can move ahead with enrollment, Drucker said.

It's a different situation, however, for some people who receive a preliminary eligibility determination for coverage from the state Medicaid program. In those cases, applicants don't have coverage until they submit information verifying their income to county officials.

Once the verifications come through, people have retroactive coverage. But those with pending applications for Medical Assistance have found the process of working with counties frustrating.

On Tuesday, Andy Dykstra, 64, of Cottage Grove said his application for coverage through MNsure had been pending since Oct. 22.

The MNsure system initially told him he'd qualify for Medical Assistance, and Dykstra received a letter Dec. 12 telling him to submit information to verify his income to officials in Washington County. Dykstra said he submitted the information on Dec. 13, but waited weeks for a final answer.

"When I call and talk to people, they tell me 'you're not the only one,' " Dykstra said.

Unsure of his status, Dykstra went ahead in early January and paid premiums of about $660 to continue coverage for himself and his wife through the state's high-risk insurance pool. Then on Thursday, a Washington County official told him they've been approved for Medical Assistance.

The frustration felt by consumers is shared by county workers, said Mary Farmer-Kubler, the financial assistance supervisor for Washington County.

County workers are trying to learn new rules for income eligibility, she said, while working with a MNsure computer system that limits their ability to make changes that might push an application forward. The system doesn't even tell Washington County exactly how many pending applications the county must handle, Farmer-Kubler said.

"These verifications are coming in, and we can't process them as quickly as we would like to because we are still learning the system ourselves," she said. "We're all struggling through this."

'IT'S AN ENORMOUS SAVINGS'

Cindy Kennedy felt the frustration when calling Ramsey County in recent weeks to check on her pending application for Medical Assistance. She said county workers told her they couldn't find the information she submitted to verify her income.

The documents were there, but Tina Curry, director of financial assistance services with Ramsey County, said Thursday that she had to sift through "bins of paper" to find them. The county can't yet scan documents into the system, she said.

Kennedy has coverage now after the Pioneer Press alerted the state Department of Human Services about her situation. State workers determined she qualifies for MinnesotaCare, and Kennedy said she's thankful for the coverage.

Previously, she paid $345 per month for health insurance, but now faces a monthly premium of just $35.

"It's an enormous savings," Kennedy said. "The only reason I left my day job to go back to school -- so I could get a better job -- was because I knew I could get insurance thanks to the Affordable Care Act."

Consumers who are unclear about their coverage and must obtain health care services should contact the Department of Human Services, said Drucker, the department spokesman. In the case of people not yet approved for Medical Assistance coverage, state officials can intervene to make sure people get care, he said.

Ralonda Mason, the attorney with St. Cloud Area Legal Services, said that navigators also can help people who must get care. But the situation is far from perfect.

"Any delay in moving people through the application process is a problem," Mason said. "People who may need to seek medical care are afraid to do that, because they don't have final confirmation of their eligibility."

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

KNOW MNSURE

For help, go to mnsure.org/help or call the help line at 1-855-366-7873.

For questions about Medical Assistance or MinnesotaCare, contact the Department of Human Services HelpDesk at 651-431-2670 or 1-800-657-3739.

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