Easier enrollment process could mean thousands more with coverage under Obamacare, researchers say

Having a seamless, one-stop shopping process for state residents to enroll in health care coverage could ensure that an additional 26,000 people get insurance, and 36,000 avoid losing their coverage, according to research released this week.

It comes amid questions about how easy it will be for the uninsured to enroll in coverage as part of federal health reform, and about how the process will be affected by outdated technology and delays in handling applications at the state Department of Social Services.

Researchers from the Urban Institute tried to quantify the significance of having an easier enrollment process for private insurance and Medicaid as the federal health reform law takes effect, expanding health care coverage to many of the state’s nearly 338,000 uninsured residents. Their work was commissioned by the Connecticut Health Foundation.

Two types of coverage

The federal health law is expected to expand coverage by creating a new marketplace for people to buy private insurance, often at discounted rates, and expanding eligibility for Medicaid. The two types of coverage are run by different agencies: the marketplace, known as Access Health CT, and DSS, which handles Medicaid.

Access Health and DSS are aiming to use a “no wrong door” approach, which would allow someone to apply for insurance only once and be considered for coverage from each agency, rather than having to submit separate applications to both or risk having paperwork lost in the process. The report said a full “no wrong door” system is critical for meeting the goals of health reform.

Matthew Buettgens, one of the researchers, said the “single most important thing” to get people covered would be to determine eligibility and allow people to enroll in real-time.

But it’s unlikely that the process will be entirely seamless by Oct. 1, when Access Health CT opens for enrollment, or Jan. 1, when the new coverage will take effect. And it’s unclear when real-time enrollment will be possible.

How easy will it be to apply?

The report noted that efforts to create a fully seamless system will be “hampered” by the limited capacity of DSS’ computer system to interact with the online application system. An important question, the authors said, will be the extent to which the state will shoulder the burden for compensating for technological limitations, such as by hiring staff to enter information manually.

DSS spokesman David Dearborn said the state has contracted with Xerox to handle data entry for applicants found to qualify for Medicaid. “This is not a limitation,” he said.

Buettgens and colleague Stan Dorn compared a scenario in which the DSS and Access Health enrollment systems were separate and one in which the state had a full “no wrong door approach.”

Under both scenarios, they projected that more than 100,000 state residents would gain insurance. But with a “no wrong door” approach, 20,000 more adults and 6,000 more children would have health care coverage. In addition, an estimated 36,000 people who would likely lose coverage at some point in the year would remain insured with a “no wrong door” system, they said.

Buettgens noted that the baseline scenario they modeled, with no integration between the DSS and Access Health systems, is not likely to be the reality in Connecticut. “It’s almost certainly going to start out better than that, with more integration than that,” he said, but added that it’s not yet clear exactly how seamless the application process will be.

One application, different handling

As currently planned, people seeking coverage will be able to apply through a single online application, whether they expect to get Medicaid or private insurance.

The system will determine what type of coverage they qualify for, and then route their case to one of three tracks: Medicaid, private insurance with a discounted rate through Access Health, or private insurance with no discount, also through Access Health.

For people who buy coverage through Access Health, the process will be fully automated, CEO Kevin Counihan said. The eligibility determination is supposed to happen in real-time, but he said it’s not yet clear whether that will be the case at first. Checking eligibility will rely in part on the state’s system getting information from a federal data hub, which is still being developed.

For Medicaid applications, the behind-the-scenes process will be more complicated because DSS’ outdated eligibility management system won’t be able to connect with the Access Health application system. People found to qualify for Medicaid will get a notice saying so, but it will take longer for them to get a Medicaid card because their information will have to be manually entered into the eligibility management system by workers at Xerox.

DSS is working to replace the eligibility management system, with a goal of having a new system in place by the end of 2015.

“For all intents and purposes, there will be a ‘no wrong door’ system in Connecticut,” when the health law’s coverage expansion takes effect Jan. 1, Dearborn, the DSS spokesman, said. He noted that people will be able to apply through the Access Health “door” and get connected to private or public coverage, while they can also apply through the DSS “door” and end up with either public or private insurance.

Encouraging online applications, discouraging paper

How applications are submitted is another issue.

About half the applications for coverage are expected to be submitted online, and Counihan said officials want to encourage as many people as possible to do so. Paper applications will require more handling, could be subject to delays and have more potential for errors, since information would have to be entered into the computer system.

“We’re going to do everything we can to communicate that the customer experience online is going to be significantly better and less risky than on paper,” Counihan said.

There will be a single, streamlined paper application Oct. 1 for both private insurance and Medicaid, Dearborn said. People will be instructed to send it to a central point, where it will be scanned and electronically transmitted to Xerox for someone to enter the data into the electronic system for determining eligibility.

Counihan noted that in Massachusetts, where he worked on that state’s insurance marketplace, roughly 80 percent of applications were submitted online, but paper seems to be more commonly used in Connecticut. He said it’s expected that about 10 percent of applications will come through a call center, half will come online and the rest will be submitted on paper.

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