Enrollments, wait times jump

By Katie Kerwin McCrimmon

Enrollments in Colorados health exchange jumped in December with an additional 5,094 people signing up for private health insurance during the first eight days of the month, according to exchange officials.

But enrollments remain well below Connect for Health Colorados lowest projections and managers are now considering revising those projections downward. (Click here to see projections.)

In the meantime, wait times to talk with a customer service agent at the exchanges call center have increased to 30 to 40 minutes.

Theyre long, exchange CEO and Executive Director Patty Fontneau conceded during a Monday board meeting.

Long wait times and other snafus concerned board member Sharon OHara who worried that frustrated consumers may never return to the exchange.

It does begin to erode the number of people who are going to come back.(and might think) Oh well. Ill just find that somewhere else or I just wont do it, said OHara, executive vice president for the Colorado-Wyoming chapter of the National Multiple Sclerosis Society.

Fontneau blamed low enrollments on three primary factors: Colorados cumbersome Medicaid application (which has since been simplified), problems with the federal health exchange that have confused consumers, and more people than expected who renewed canceled health plans and therefore are not shopping on the exchange. (Click here to read Canceled plans wont be resurrected in Colorado.)

To help jumpstart sales, managers are spending an additional $200,000 to $300,000 this month to hire a private contractor to deploy about 50 people to call hot leads, people who have already begun to fill out applications, and try to sell them private health plans. The funds will come from $177 million in taxpayer-funded grants from the federal government.

Altogether since Colorados state-run exchange opened on Oct. 1, 15,074 people have signed up through the exchange while Colorado has added more than 65,000 people to its Medicaid rolls.

Sign-ups for private health insurance have been slower than expected. December is the peak month during which exchange managers had expected to sell private health plans. On the high end, they had hoped to sell 62,000 plans this month alone. The low projection calls for sales of 22,000 plans

Pay raises irk Gardner

U.S. Rep. Cory Gardner was outraged that exchange director Patty Fontneau was seeking a raise when enrollments were lagging.

While enrollments fell below expectations, Fontneau, drew the ire of U.S. Rep. Cory Gardner, R-Yuma, who vowed to introduce legislation in Congress this week banning any pay raises or bonuses for executives of state-based health exchanges.
(Solutions first reported Fontneaus request for a raise and bonus last month. Click here to read Exchange boss wants pay hike.)

In response, Fontneau withdrew her request for a raise on Friday. (Click here to read Exchange boss withdraws request for pay hike.)

At a Monday meeting, board member Arnold Salazar, executive director of Colorado Health Partnerships, defended the Colorado exchanges launch.

He was angry about media attention to Fontneaus salary and a focus on enrollments. He said the exchange is entirely new and it was difficult to predict how many people would sign up.

In my opinion, weve done an exceptional job, Salazar said.

But board member Steve ErkenBrack, who is president of Rocky Mountain Health Plans, said its critical to remember that Colorados health exchange set its own expectations.

Weve got to react to reality. This is a long-term marathonbut people are concerned about this and I share their concerns, ErkenBrack said.

Gov. John Hickenloopers Deputy Chief of Staff Kevin Patterson also urged quick action from exchange managers.

Weve got to solve the problem that we have today. What can we do between now and tomorrow that will make the day after that better? said Patterson, who is a non-voting member of the exchange boared.

ErkenBrack repeatedly pressed for any possible solutions to make sure people who are losing coverage on Dec. 31 will have time to sign up for new plans. He wants state officials to consider asking for a short-term waiver from the federal government so people who think they wont qualify for Medicaid can go ahead and buy private insurance.

Medicaid form slowed sign-ups

In Colorado, sign-ups for private health insurance have been slowed in part because anyone who wants to qualify for tax subsidies must first fill out an application for Medicaid and receive a denial. Receiving a denial can take as long as 45 days, which pushes applicants well past the Dec. 23 deadline to buy insurance through the exchange and have coverage start on Jan. 1.

Sue Birch, who heads Colorados Medicaid programs, said on Monday that her agency is catching up on people who have been waiting for denials. As of Monday, the person who has waited the longest has been stuck without an approval or denial for 38 days, Birch said. (Solutions wrote about a woman who waited 37 days. Click here to read After 37-day delay, cancer patient gets insurance.)

Altogether since Oct. 1, Birch said Medicaid managers have cleared about 16,000 people who were waiting to learn if they qualified for Medicaid or could move forward with purchases on the exchange.

A backlog of about 2,300 cases remains and Birch said she hopes her staffers will clear that by Friday. But they also have to handle about 1,100 new cases each day for people who could not find out in real time if they qualified for Medicaid.
Birch said about 70 to 82 percent of applicants are getting real time approvals or denials. She blamed many of the snags on people who enter their data incorrectly and names that dont match Social Security numbers.

We have a lot of human error in this process, Birch said.

Kevin Patterson, Gov. Hickenloopers deputy chief of staff, pressed for immediate solutions to exchange problems: Weve got to solve the problem that we have today. What can we do between now and tomorrow that will make the day after that better? To Pattersons right is exchange board member Richard Betts.

Furthermore, she said some of the most complex cases could be people who are falsifying their information.

They are fraught with fraudso we take time to find these people, Birch said.

She said none of the denials has stretched beyond the 45 days that the federal government allows, and commended her staff for getting so many people added to Medicaid so quickly.

This is 10 percent of our states uninsured, Birch said of approximately 65,000 people who have been added so far. Its an extraordinary success.

Colorado has an estimated 741,000 uninsured people according to the latest estimates from the Colorado Health Access Survey.

Like exchange officials, Birch conceded that her customer service agents also cant handle all the calls theyre getting.

Right now, people are having to hold. We dont find that acceptable either. All in all, we feel like we are trying to respond and (adjust daily), Birch said.

Birch estimated that her department has given exchange managers the names of about 40,000 people who received denials.

ErkenBrack said hes extremely concerned about the 1,000 people a day who are not getting real-time denials along with the deluge of people who are not getting speedy help through Connect for Health.

This isnt about HCPF (Colorados Medicaid agency) or the staff at the exchange. Its about each of these people whose policies are going away, ErkenBrack said.

This continues to be a huge concern for me, he said.

Birch responded that she continues to talk with federal officials, and that shes considering a cutoff of Dec. 20 for Medicaid applications so anyone who gets a denial can still buy private insurance. Fontneau said its not clear that all private health insurance companies are willing to process applications they receive as late as Dec. 23 for coverage thats supposed to start on Jan. 1.

Getting people covered crucial

Board Chair Gretchen Hammer also noted that uninsured people need coverage as soon as possible, not just those who are losing insurance at the end of this month. Hammer is executive director of the Colorado Coalition for the Medically Underserved.

Board member Eric Grossman pressed for increased sales.

It looks like the state is doing its job, Grossman said of the 40,000 leads Connect for Health has received for people who have already completed a Medicaid application.

Its not an insignificant number, Grossman said.

It would seem helpful to see how were progressing at conversion of those applications. What are we doing day to day so we dont have to come up with very creative ideas (like asking for federal waivers).

Grossman has pressed exchange managers to focus intently on sales and to carefully consider the most efficient ways to boost sales.

You could argue that those are pretty motivated people, Grossman said.

This is our focus, taking those people who are most likely to enroll (and getting them enrolled), Fontneau said.

The work better get done fast, ErkenBrack said.

We live in a real world and made a decision to send notices to hundreds of thousands of Coloradans terminating their policies on Dec. 31. Theyre very concerned about that, he said. If we get 98 percent covered, there are still 2 percent that are not covered.