Maryland gears up for health exchange redo


Gov. Martin O’Malley, right, holds up a phone number to get help enrolling in health insurance in the state’s health care exchange. Health Secretary Dr. Joshua Sharfstein and Carolyn Quattrocki, the interim director of the exchangem join him. (Brian Witte/AP)

On Monday, the first enrollment period for health insurance plans made possible by the Affordable Care Act will end, so call centers in Maryland plan to stay open until midnight in a last-minute effort to boost enrollment numbers.

Then on Tuesday, Maryland will begin the process of replacing its troubled exchange, which has had so many problems since its launch on Oct. 1 that officials have decided it would be better to start anew.

Maryland had more than two years to create its first exchange, which has cost $125.5 million to build and operate, according to the exchange’s spokeswoman. The state now has about seven months to replace that system, a feat that will likely cost tens of millions of dollars. The second enrollment period opens Nov. 15.

The exchange’s board plans to vote Tuesday to use technology from Connecticut, which has had one of the most successful exchanges in the country, and hire the contractor that built that system, Deloitte, according to two people familiar with the decision. Maryland Gov. Martin O’Malley (D) and other state officials have said they will not discuss their plans until a decision is finalized.

As of Sunday afternoon, leading lawmakers had not been briefed on what is in the works. A legislative oversight committee formed earlier this year amid mounting problems with the system plans to meet Thursday afternoon to discuss the future of the exchange, said Sen. Thomas M. Middleton (D-Charles), the co-chairman.

“I am sure questions will be: What led to the decision? How much money will this cost? What’s the timeline? Are we going to be able to have an exchange up and working by November?” Middleton said. “There is a sense of relief now that we’re getting to the deadline [for open enrollment]. Now we can just focus on getting it right.”

Also on Thursday, the U.S. House Committee on Oversight and Government Reform is scheduled to hold a hearing focused on “problem-filled state exchanges.” Joshua M. Sharfstein, Maryland’s secretary for health and mental hygiene, is scheduled to testify, according to his spokeswoman.

Maryland was one of 14 states to build its own health insurance marketplace rather than use the federal one. It has been one of the worst performing in the country.

Maryland had signed up only about 9 percent of its pool of potential private plan enrollees as of March 1, according to the Henry J. Kaiser Family Foundation, which has been tracking state-by-state enrollments. By comparison, Connecticut had enrolled more than 26 percent, one of the highest rates in the country. Nationally, the rate is around 15 percent.

Maryland’s Web site crashed on its first day, and even after hundreds of fixes, the site still will not work for some users and it sometimes struggles to send enrollment information to the right places. Fighting between the state’s main contractor, Noridian Healthcare Solutions, and its main subcontractor, EngagePoint, erupted into a nasty legal battle. Maryland fired Noridian in late February.

Originally, Maryland hoped to enroll at least 150,000 people in private plans. Recently, researchers have said that a more accurate projection is 75,000 to 100,000. As of March 22, enrollment was 49,293.

Medicaid enrollments have exceeded expectations, which state officials say will reduce the expense of uncompensated care. Nearly 96,000 people were automatically enrolled when the state expanded its Medicaid program, and more than 124,000 additional people have enrolled.

The Medicaid enrollment success has allowed the state to meet its overall goal of getting at least 260,000 people covered. O’Malley held a news conference Friday to announce that Medicaid and private plan enrollments totaled 274,582.

News that Maryland plans to adopt technology from Connecticut was encouraging to those who have struggled with the current system.

Leni Preston, chair of the Maryland Women’s Coalition for Health Care Reform, has regularly attended exchange board meetings and said that “it’s been very clear something drastic had to happen” to fix Maryland’s system.

Connecticut’s reputation for smooth operations “gives us a warm and fuzzy feeling,” Preston said. But she added that because each state’s Medicaid process varies, adapting Connecticut’s system to meet Maryland’s needs “is something that still has to be watched.”

Peter Beilenson — the founder of Evergreen Health Co-op, a start-up insurance and health-care company that is participating in the exchange — has explored Connecticut’s Web site. He is impressed that people can shop for plans, seeing estimated prices and offerings, before having to input their personal information.

“It’s really fast,” Beilenson said. “It seems to work really smoothly.”

But Beilenson said that he has already asked the state to reimburse insurance carriers for expenses related to switching to a new system. He is unsure how much that will be.

Jenna Johnson writes about Maryland politics, including the General Assembly, the administration of Gov. Martin O'Malley and the 2014 election.
Mary Pat Flaherty works on investigative and long-range stories. Her work has won numerous national awards, including the Pulitzer Prize.
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