Maine vows to fix hiccups found in 1st year of health care marketplace rollout

·4 min read

Jan. 19—AUGUSTA, Maine — Maine's first year of running its own health insurance exchange came with double-digit enrollment increases and communication and navigation challenges that the state told lawmakers Tuesday it wants to fix before the next enrollment period.

The state's exchange, CoverME.gov, which allows residents to shop for health insurance plans under the Affordable Care Act as well as sign up for MaineCare, the state's version of Medicaid, rolled out last year. It was a priority of Gov. Janet Mills, a Democrat who signed a 2020 bill paving the way for Maine to implement its own marketplace instead of using the federal one.

There are signs the program's first year went well after it rolled out in November with open enrollment ending last week. Some 66,000 Mainers enrolled in marketplace plans, a 10 percent increase from the previous year. People also purchased more plans offering better coverage, something officials said was likely due to subsidies under the American Rescue Plan Act, with the state's health commissioner calling it a "successful" rollout.

But ramping up the new system also came with problems for consumers and brokers, something members of the Legislature's health committee are concerned may lead to coverage gaps. The state is vowing to fix those problems ahead of the next enrollment period.

That is crucial because the program may become more prevalent in Maine's insurance landscape after a federal mandate requiring states to keep Medicaid recipients enrolled comes to an end. It was extended through April under the public health emergency caused by the COVID-19 pandemic, which caused the program's rolls to grow.

"If they are continuing to run into these problems, and we don't get them figured out until after the enrollment period, then obviously there's implications there," said Sen. Trey Stewart, R-Presque Isle, said at a state briefing of the health panel on Tuesday.

Common problems included slow response times to technical issues and call-center employees who were not fully educated in solving more complex questions. Complicated cases were also a barrier as well as following up on problems being worked through.

"They're calling in because they've either encountered an issue or they have a complex scenario that maybe requires the marketplace to intervene or make changes on their behalf," said Meg Garratt-Reed, the director of Maine's marketplace.

Lawmakers reported that insurance brokers working on behalf of clients at times struggled to navigate the website. The state also ran into problems with ZIP code and other data imported from the federal Healthcare.gov website, Garratt-Reed said, which at times made it difficult to process applications. Complex tax structures within a household also posed challenges.

Still, Garratt-Reed said the enrollment figures exceeded expectations and showed "exciting" potential for the program's future. The state has worked to fix problems by increasing training for call center employees and offering material to teach brokers how to navigate the system, according to Garratt-Reed. In cases where solving problems took more time, she said the state offered more flexibility around deadlines to prevent people from missing out on coverage.

Those efforts seemed to make a difference, she said. The department reported customer satisfaction was ranked at 77 percent in October but had increased to 89 percent by this month.

Maine officials lauded the program's rollout, which advocates said would allow for more streamlined plan shopping and make it easier for the state to sign people up for MaineCare, with Health and Human Services Commissioner Jeanne Lambrew saying it was a "successful inaugural year."

The department's responsiveness and willingness to work with consumers was critical to seeing the increase in enrollees and the state's efforts to fix the program would improve it, said Ann Woloson, executive director of Maine Consumers for Affordable Health Care.

"There are bound to be issues with any new technology or platform," she said.

The department is also preparing for the end of the public health emergency, Garratt-Reed said. Many may now be eligible for marketplace insurance, and she said it will be critical for the department to reach out to them before coverage lapses. That period worries many health officials, but Garratt-Reed said Maine having its own program will allow for more flexibility.

"We can work and tailor our solution to our systems and what we know are our strengths, but also the potential challenges we may face here," she said.

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