Update 12-23-19 at 2:19 p.m.: The Silver State Health Insurance Exchange has announced that 77,410 Nevadans enrolled during open enrollment, down about 6,000 from the 83,647 that signed up last year.

Nevada’s health insurance exchange is extending its open enrollment period through Friday for people who began applications for coverage but had not finished them by the Sunday deadline, a move exchange officials are hoping will boost registration amid reports of flagging signups during the 45-day period.

Even with the extension, Heather Korbulic, the exchange’s executive director, predicted that signups this year will be “slightly down” over last year’s enrollment total, 83,449. But she also cautioned that this year’s numbers, which the exchange won’t release publicly until Dec. 23, should be viewed as a new baseline for enrollment after the exchange transitioned this year to a fully state-run platform for enrolling Nevadans in health insurance plans through the individual marketplace.

Nevada’s enrollment totals were previously released by the U.S. Centers for Medicare and Medicaid Services, which operates the federal HealthCare.gov platform the state previously used to enroll Nevadans in plans. But Korbulic said that, historically, when the exchange received the numbers of enrolled members from insurance companies in January, it was never as many people as CMS initially reported.

When the exchange transitioned enrollees over from the federal HealthCare.gov system in October to set up the new state-based platform, there were about 65,000 signed up, Korbulic said. 

“There's a huge divide every year, and we've been basically forced to use CMS's produced number because that's what's public,” Korbulic said. “But we know that there's never been that many people.”

Korbulic added that the exchange is “definitely showing growth” from that 65,000 number but that the 2020 enrollment numbers should also be viewed in the context of dropping enrollment nationally. Last week, the federal government reported that enrollment was down about 6 percent over the prior year, which some experts have attributed to a lack of marketing by the Trump administration about open enrollment.

“In general, we're trending around the same as the national level,” Korbulic said. “We're hoping to do some catch up this week with people who had started and bring ourselves a little bit closer to last year's numbers.”

That catch-up period wouldn’t have even been possible in prior years when the state enrolled Nevadans in plans through HealthCare.gov, a system that provided little data to the health insurance exchange and offered little flexibility.

“This is another opportunity for us. We can reach out directly to those people,” Korbulic said. “We never had an opportunity to do that before.”

Korbulic said that the exchange had been talking about a possible five-day extension with the insurance companies who offer plans on the exchange as far back as August, but wanted to keep pushing the Dec. 15 deadline in an effort to get as many people to enroll as possible. The exchange notified an unspecified number of people who began plans but had not completed them of the extension in an email Monday morning.

She said that there haven’t been any particular portions of the applications that those people have gotten stuck on and attributes it more to the end-of-the-year crunch of people looking at the cost of the health insurance plans amid other budgeting priorities, including holiday expenses.

“It's always been tricky to do enrollment during the month of December when people are purchasing Christmas presents and thinking about the holidays and not thinking about the next year of health,” Korbulic said.

Even after the five-day window closes, the exchange may get another late enrollment boost from about 21,000 people who were directed to apply for Medicaid but were determined to be ineligible. Those individuals have a 60-day window from the time that they were denied Medicaid to apply for insurance through the exchange.

“I'm stunned by the volume that we're getting from [Medicaid] and really curious about what's gone on in years past and thinking through how we can do a better job of closing the gap and providing that safety net,” Korbulic said.

When the dust of open enrollment settles, the exchange will also be able to, for the first time, drill down into the numbers of people who were passively re-enrolled into exchange plans compared to new enrollees or those existing enrollees who took action to select a new plan during open enrollment, which will allow the exchange to prepare and make changes for next year.

“We've got insight into our numbers for the first time in a real and comprehensive way,” Korbulic said.

Some of those possible changes include small tweaks such as rewriting questions that were aligned with federal requirements but were confusing to enrollees and more wholesale changes, including lengthening the open enrollment period.

“I think there's just a lot of good opportunity. We're being as open minded as possible,” Korbulic said. “If we get through the needs and get into the wants, I think we'll be really happy.”

All in all, Korbulic said the exchange received few complaints about the open enrollment process and had a 98 percent customer satisfaction response through the call center it operated.

“I'm still trying to get myself out of the trees and see the forest here,” Korbulic said, “but we are pretty proud of having on time, under budget technology project in a state agency, which is a pretty significant accomplishment.”