STATE HOUSE, BOSTON, OCT. 9, 2014…..As pressure mounts on health officials for a successful relaunch of the state’s health insurance exchange, Congressional Republicans on Thursday raised new questions about the legality of the Obama administration authorizing the use of federal Medicaid dollars to bail out Massachusetts through a temporary program aimed at ensuring no residents lost health coverage.
Republican gubernatorial candidate Charlie Baker also followed up concerns raised during Tuesday night’s debate with Attorney General Martha Coakley, criticizing her leadership before the website’s initial failure last fall.
The Health Connector board met Thursday morning to receive a status report on the work being done to prepare the website to go live on Nov. 15 for the start of open enrollment.
Patrick administration officials and project managers expressed confidence that the site would be ready in time, walking the board through testing being done to ensure consumers will have a seamless shopping experience for health coverage.
“We believe the website will work,” said Maydad Cohen, the special advisor to Gov. Deval Patrick put in charge of completing the exchange website after last year’s disastrous rollout.
While Cohen cautioned that no technology launch is ever “perfect,” board member Dolores Mitchell gave voice to the scrutiny the project will be under once it goes live for the public.
“There are a lot of people out there waiting for this thing to fail and it won’t take a lot of reports of people having trouble for people to say, ‘Oh, here we go.'” Mitchell said, asking whether the team is prepared to monitor and respond quickly to transactions and problems consumers might encounter.
While the Health Connector team is focused on getting ready for next month’s launch, Baker on Thursday said Coakley’s defense of her appointees to the Connector board shows she’s “not up to the task” of leading as governor.
Meanwhile, U.S. Rep. Fred Upton, a Michigan Republican and chair of the Committee on Energy and Commerce, and Sen. Orrin Hatch, a Utah Republican and ranking member of the Senate Finance Committee, wrote a letter to the head of the Centers for Medicare and Medicaid Services on Thursday asking the agency to explain why Massachusetts was allowed to use Medicaid dollars to insure a population that might not qualify.
“First, we are deeply concerned that CMS allowed Massachusetts to use the federal Medicaid funds to provide coverage to individuals who may not be eligible for Medicaid but were unable to secure coverage through the state’s health care exchange due to technical problems,” Upton and Hatch wrote to CMS Administrator Marilyn Tavenner.
When the state’s eligibility determination system failed last fall, the Patrick administration received permission to place over 306,000 applicants into temporary MassHealth coverage, with a 50 percent federal reimbursement.
State officials say they are confident that vast majority of that population would have qualified for either Medicaid or a subsidized ACA health plan, but have no way of knowing yet how many might have incomes above the threshold for subsidies.
In fiscal 2014, Secretary of Administration and Finance Glen Shor reported that the state spent $139 million on the temporary MassHealth population, half of which will be reimbursed by the federal government. From July through September, the state has paid an additional $182 million for temporary Medicaid coverage before federal reimbursement.
Massachusetts has requested an extension from CMS to continue the temporary Medicaid program through the end of the year, giving consumers time to apply for permanent coverage through the new exchange starting Nov. 15.
“We believe it an inappropriate use of federal Medicaid funds to temporarily enroll thousands of individuals in Medicaid, especially since CMS knows that many of these individuals are not eligible for Medicaid coverage,” Upton and Hatch wrote. “Additionally, there are serious questions regarding CMS’ legal authority to take such action.”
Cohen said Massachusetts expects to “true up” with CMS after open enrollment, which could include higher reimbursements under the ACA for individuals who qualify for Medicaid or another subsidized plan.
Baker criticized Coakley for not doing more to intervene before the Connector launched its first failed attempt at a web-based exchange last fall. Coakley defended her three appointees to the Connector board, while Baker said Massachusetts was the only state where no one lost their job after such a poor rollout of the Affordable Care Act exchange.
“The Attorney General is wrong to paper over the massive disaster that is the Health Connector when her appointees were clearly aware the website was not ready to launch,” Baker said Thursday.
During a radio interview Thursday, Gov. Patrick said his administration had faced up to the problems with the website and fixed them, alleging Baker had hid Big Dig financing problems while serving in the Weld administration. Patrick also said he did not employ “ritual resignations” as part of the administration’s strategy to fix the site.
Nancy Turnbull, one of Coakley’s appointees, declined to comment on Baker’s criticisms Thursday after the board meeting, but Louis Malzone, another Coakley appointee, stuck up for the attorney general.
“It’s easy for him to say when he was sitting at home doing nothing. From my perspective, you have to walk in someone else’s shoes. I think the attorney general did a great job being there to support us in the critical time and I’m happy to have served under her leadership,” Malzone told the News Service. “He can say anything he wants. He can throw stones at her about this issue, but frankly from my point of view, he wasn’t there.”
Malzone credited Gov. Deval Patrick and Coakley with turning around the troubled IT project in a “relatively short amount of time.”
“We were engaged. I think we knew when it became important to know,” Malzone said about his awareness of the problems with the website before last year’s launch. “I personally feel we made a bad choice, in retrospect, with the vendor. We thought we made a good decision because we were going to coattail on the federal government’s choice, but when the feds failed, we failed.”
Bill Oates, the state’s chief information officer, told the Connector board he was confident in the security systems in place to protect personal data entered into the site by applicants for health insurance.
“Optum brings a depth of experience in privacy in health information,” Oates said, noting the IT vendor’s handling of personal health information for over 70 million consumers around the country.
The state’s IT team is in the process of completing security and privacy accreditations through the Centers for Medicare and Medicaid Services and the Internal Revenue Service, and Oates said that despite last year’s troubles no data breaches occurred. At least three independent reviews have been conducted on the current system, and Coal Fire, an IT auditing firm, is conducting “vulnerability and penetration tests” on the system this month.
“That is a third party going in and banging on the system making sure it can support the security thresholds we have,” Oates said.
In the event that components of the website do fail after launch, project managers said there are contingencies in place to switch off pieces temporarily without taking the whole system down, or reverting to an older, more stable version of the site with customer service and manual “workarounds” at the ready.
Copyright 2014 State House News Service