As MD’s Health Insurance Exchange Moves on to Next Phase, Enrollment Continues

Many Maryland residents can continue to sign up for health insurance under the Affordable Care Act even though the first open enrollment period for the state’s health insurance exchange – Maryland Health Connection --ended this week. In the meantime,  the state is  turning toward doing a better job of managing things for the next  open enrollment period, which begins on November 15.

While there are various deadline for getting health insurance under the Affordable Care Act, there are also several exceptions. Medicaid enrollment is available year-round. As a result of Maryland’s decision to expand Medicaid under the new law, thousands of residents are newly eligible. Though many have already enrolled, those who  have not—or did not previously qualify—don’t  need to  wait for the next open enrollment period to do so. They can enroll at any time.

Second, many others are still eligible to enroll in private coverage through Maryland’s exchange. This includes those who were not able to sign up during the open enrollment period due to technical problems, provided that they called the hotline the state set up to report their problem. This likely includes thousands of residents.

In addition, the law makes available ‘‘Special Enrollment Periods’’ that allow anyone who  has experienced a change in circumstances during the year to sign up outside the normal enrollment period. This can include getting married, having a child, losing a job or employer-sponsored insurance, divorce, or the death of a spouse. Further, if your income  income changes and you become  eligible for subsidies to help you pay for  private insurance, you can  enroll or re-enroll in subsidized coverage at any time. More information on Special Enrollment Periods is available at the Maryland Health Connection.

Of course, the state now faces  the task of overhauling its exchange before open enrollment begins anew in November. This involves both correcting the problems that plagued the Maryland Health Connection since its launch last year, as well as efforts to build on the successes of the exchange’s first year.

On Tuesday, Maryland’s Health Exchange Board voted to replace its flawed information systems  with the technology used to run Connecticut’s largely successful state exchange, implemented and maintained by the consulting company Deloitte. Secretary of Health and Mental Hygiene Joshua Sharfstein and Isabela FitzGerald, Maryland’s Secretary of Information Technology, explained that doing so was the least expensive option and also met Maryland’s timeframe and needs. Connecticut’s exchange is described as “a simpler, streamlined system.” Rebuilding the exchange would take too long and would be too expensive ($66 million). Moving to the federal exchange would pose similar problems and  raise additional issues about the exchange’s ability to communicate with the state Medicaid program. While the software code for Connecticut’s exchange is in the public domain and thus freely available, Secretary FitzGerald expects that it will still cost the state $40-50 million to implement. It is still  unclear how much of this cost will be covered by the federal government, as much of the $125 million for the original exchange was.

However, just as Maryland is working to correct the missteps from this first year of running its health insurance exchange, lawmakers should also recognize and build upon its successes. First, we already know that Maryland surpassed its initial enrollment projections. Almost 300,000 men, women and children  are known to have enrolled - 232,000 in Medicaid and 63,000 in private plans – and this does not reflect the surge of sign-ups during the final days of open enrollment, nor those who have more time to enroll due to technical difficulties.

Many of these people are newly ensured, and all will enjoy more financial security as a result of being covered. This is important progress. This large increase in the number of Marylanders with health coverage followed “a decade or more of people losing health coverage and a steady erosion in the financial protection of insurance, [which] put middle-income families at risk” nationwide, according to a recent report by the Commonwealth Fund.

In the coming weeks and months, we will delve deeper into the issues surrounding Maryland’s implementation of the Affordable Care Act, considering both what worked and what did not, discuss policy options for improvement and reform, and provide data and analysis on how health reform is impacting Maryland. Keep checking back here for more.