State officials told a House committee on Wednesday that they have a plan for tackling eligibility errors as people go through MNsure to qualify for public health insurance programs.
The plan already has delivered improvements, they say, since the period covered in a recent audit that suggested thousands of people last year didn’t qualify for their coverage, costing the state up to $271 million.
“While the system we have today has been improved compared to the system that was audited in early 2015, there’s no doubt there’s more work to be done,” said Tom Baden, the commissioner of the state’s MN.IT department, during a hearing near the Capitol in St. Paul.
“My ask is that we don’t stop, admire the problem for six months and then ramp up again,” Baden said, referring to an early 2014 pause in developing the MNsure IT system as state officials evaluated whether to change course. “If we pause again, I think we’ll lose the momentum we gained in 2015.”
The report issued in January by Legislative Auditor James Nobles looked at a sample of cases from early 2015 and found errors in 38 percent of those who enrolled through the state’s health insurance exchange in either the Medical Assistance or MinnesotaCare programs.
Auditors applied the error rate to a larger group that enrolled through MNsure to project the potential cost of problems that were a mix of computer issues, inadequate training and human error.
The state Department of Human Services (DHS), which uses the MNsure system for enrollment and eligibility in the programs, said the report points to issues that it continues to address, but questioned whether the audit overstates the problem.
During Wednesday’s hearing, DFLers and Republicans took up the methodological debate, with Rep. Tina Liebling, DFL-Rochester, saying she seriously questioned the numbers. Auditors looked at many enrollees who had not yet gone through the DHS renewal process, which was designed to verify eligibility.
“We all want people to be verified properly,” Liebling said. “What we need from your office is something that helps us get that done, and I’m really struggling to see how this does that.”
Republicans embraced the findings, with Rep. Nick Zerwas, R-Elk River, saying they support his party’s call last year for better checks on eligibility. They pushed legislation last year for quarterly checks of eligibility by an outside party.
“We can blame the [auditor] for bringing this to our attention, or we can try to work toward solutions,” Zerwas said. “I think we should try to work toward solutions.”
Rep. Glenn Gruenhagen, R-Glencoe, said the findings were more evidence that the state needs a dramatic shift in strategy when it comes to MNsure. His party has suggested moving away from a state-based health exchange to the federal government’s HealthCare.gov website, which is used in the majority of states.
“We have to recognize this has been a failure,” Gruenhagen said. “And trying to keep the health care Titanic called MNsure afloat is useless and … a waste of taxpayer dollars.”
But Liebling said such comments promote a misunderstanding of the issue. The problems identified by the audit shouldn’t be attributed to MNsure, Liebling said, but to DHS.
Even if the state moved to the federal government’s exchange, it would still have to resolve problems with the enrollment and eligibility system, she said.
“I don’t think it helps that to just be, ‘Well, let’s get rid of MNsure, let’s get rid of this,’ because what is the alternative?” Liebling asked. “We had a task force look at the alternatives, and they said the federal [exchange] is not an alternative.”
Nobles’ audit was directed at DHS, but in 70 pages the report mentions MNsure more than 250 times. A MNsure official, however, told the committee Wednesday that she could not comment on the report because “this specific audit was not on MNsure.”
When the state launched MNsure in 2013, it was designed to handle eligibility for tax credits that subsidize private insurance coverage. The health exchange IT system also was meant to handle enrollment and eligibility in the public health insurance programs.
Until last year, state officials used the name “MNsure” when talking about portion of the system for public programs, but have since started using the name Minnesota Eligibility Technology System (METS).
Nobles told lawmakers Wednesday that they should clear up confusion about whether MNsure, DHS, METS or some other group is responsible for fixing the eligibility problems.
“We called it MNsure because that’s the only thing that’s been in state law — that’s the thing that got the money,” Nobles said.
“Now you want to divorce it, and METS will be a different thing from MNsure …,” he said. “Who is in charge of it? Who is accountable for it? It’s kind of a committee. … You can take the face off of this thing called MNsure and set it apart, because that’s where all the politics is … but make somebody responsible for it. Make somebody accountable for it.”