MNsure struggles with incomplete records that could affect coverage

As MNsure prepares for its next big enrollment push, state officials are grappling with a stubborn problem from the first year of the health insurance exchange.

Cumbersome aspects of the MNsure enrollment system mean there's a backlog of more than 30,000 "life events" that government workers must record for people who've already obtained coverage through the online marketplace.

The changes can include anything, from the birth of a child to a drop in income. Failure to record the events means some people could go without coverage, advocates say, either because they can't get into a program or because they're asked to pay more for insurance than they can afford.

MNsure says it's making headway in resolving the problems among those with commercial health insurance through the exchange. State officials are making a new push to get changes made so people can easily renew coverage in public health insurance programs on Jan. 1.

"It's been a big issue," said Ralonda Mason, supervising attorney with Mid-Minnesota Legal Aid, which helps people seeking health insurance.

About 300,000 people have used MNsure in its first year to enroll in public health insurance, and about 50,000 people have used the exchange to buy commercial policies.

Currently, there are about 23,000 changes that the state Department of Human Services has tracked for people in public health insurance programs — largely for those covered by a program called MinnesotaCare. The department estimates that another 10,000 changes must be made for people in Medical Assistance, which is Minnesota's version of the state-federal Medicaid program for residents near the poverty line.

At MNsure, about 1,918 changes must be made for people in commercial insurance policies. The figure that likely corresponds with the number of people affected by the changes, as well, but the estimate isn't precise, said Joe Campbell, a MNsure spokesman.

The trouble with life events surfaced this summer, when some moms complained they weren't able to quickly get newborns added to their coverage through MNsure. State officials said they were focused on resolving issues for the babies and stressed they were able to get changes made quickly so people would have coverage in cases of emergencies.

Some of the changes that haven't yet been made likely won't affect what people should pay for coverage, or whether they have insurance, said Chuck Johnson deputy commissioner of the Department of Human Services.

But higher-stakes changes are in the mix, including about 700 cases that would create coverage in public health insurance programs. Each change could provide benefits to one or more people, state officials say. At MNsure, there were about 300 cases in late October in which people needed to be added to coverage in commercial health insurance policies.

Katie Burns, the chief operating officer at MNsure, said she's been encouraged by recent progress in working down the backlog among those with commercial coverage. In September, the exchange hired about 175 temporary workers to handle phone calls, and the increased staffing has helped the exchange make more changes, Burns said.

At the Department of Human Services, about 100 workers are starting to make the changes, each of which can take anywhere from five to 45 minutes to make, Johnson said.

Workers handling the task should have time, Johnson said, because previously they were inputting thousands of paper applications for people seeking MNsure coverage. Later in November, the work on paper applications will move to county workers across the state.

"I don't know that we'll necessarily get through all 33,000 [life events], but that isn't necessarily the goal over the next few weeks here," Johnson said.

Noting that all MinnesotaCare beneficiaries, and a large chunk of those in Medical Assistance, are scheduled to renew coverage in the programs as of Jan. 1, he added: "I'm confident that we'll be able to move through as many as we can in order to get us ready for the renewals."

Once life events are recorded in the system, some of the changes could move people from eligibility for one type of financial assistance to another, advocates say.

"For a while, they didn't have a process on how to process these, so they were just kind of piling up," said Kate Pappas, who works as a health insurance navigator at Community University Health Care Center in Minneapolis. "Because of the backlog, they're still working to get caught up."

In other cases, the system is slow to record that a new spouse or child has come into the household and needs to be added to coverage, said Mason with Mid-Minnesota Legal Aid.

There have been some improvements with the MNsure system, Mason said, so she has some optimism about the state getting more changes made in the coming weeks. Even so, she said, the problem with life events is big.

"There are people who are eligible for Medical Assistance who are not getting it," she said. "They're not getting it because they're not being added to a household, or their income has changed and they're eligible for a new program and they're not getting moved into it."

Christopher Snowbeck • 612-673-4744