The biggest test for Nevada’s health insurance exchange begins today.
The exchange is launching — for the second time in its six-year history — a fully state-run platform to enroll Nevadans in health insurance plans through the individual marketplace. In the simplest of terms, that means no longer will Nevadans sign up for health insurance plans through the federal healthcare.gov platform but through the state-run nevadahealthlink.com website.
But the shift, which officially begins as the 45-day open enrollment period kicks off today, is more than just a URL change. It represents a fundamental reshaping of the role that the state plays in connecting Nevadans to health insurance and one that has been years in the making.
Since 2014, Nevada has relied on the federal platform to enroll its residents in individual health insurance plans while still maintaining a state-based exchange, the Silver State Health Insurance Exchange, to carry out all other exchange functions — what’s known as a state-based marketplace operating on the federal platform. But relying on the federal platform even just to carry out the IT functions of enrollment tied the exchange’s hands in many ways, including preventing it from accessing much of the data on who in Nevada actually purchases health insurance through the exchange and conducting targeted, direct outreach to those individuals.
It also was getting increasingly expensive to use the federal platform. The exchange has estimated that using the federal platform would have cost it $12 million in fiscal year 2021, compared to only $6 million if it shifted to an entirely state-run platform.
So the exchange decided to make the leap and has, for the past couple of years, been in the process of transitioning to a state-based system, which goes live today.
The platform had its soft launch in September, when the exchange began reaching out to Nevadans currently covered under exchange plans to get them to claim their healthcare.gov accounts on the new state website — the most technically complicated part of the project, since it required data migration from the federal servers to the state system. Since then, a little more than 30 percent of people have claimed their new accounts through the state’s website, according to the exchange.
The second soft launch was on Oct. 4, when the website opened for a window shopping period, where people were able to view the different plans offered through the exchange and the varying rates but not yet apply for them.
Now, Nevadans can officially begin enrolling in those plans through the state system.
There’s extra pressure riding on the launch, though.
When the exchange first launched in 2013, Nevada had an entirely state-run system, developed by Xerox. But that initial system was plagued with computer errors and billing and enrollment programs — with some enrollees complaining they paid for insurance they never received — and the state quickly dropped the contract and switched over to the federal platform.
Heather Korbulic, the exchange’s executive director since 2016, is keenly aware of the expectations on today’s launch. But she said the exchange is “pretty confident” in its system.
“We’ve been working really hard in the background confirming and reconfirming and testing and retesting things that were necessary to demonstrate our ability to launch on Nov. 1,” Korbulic said in an interview this week. “We’re feeling pretty good about having a successful launch.”
She said she’s expecting some speed bumps with a project of this magnitude and scope, but that the exchange has done everything it can to think through all potential problems and put a system in place for dealing with any issues as they arise. The company that developed the new state-run platform, GetInsured, has a team standing by — in addition to exchange staff — to respond to any issues, she said.
“I’m feeling pretty good, although anxious, because I think for me and for the exchange in general we have even more pressure to get this right because of Nevada’s history,” Korublic said.
There’s added pressure, too, because Nevada is the first of a handful of states transitioning to a state-based marketplace over the next few years. New Jersey and Pennsylvania are planning to switch next year for the 2021 open enrollment period, while New Mexico will do so the following year, according to an analysis by the Commonwealth Fund.
“The pressure from all sorts of national interest has been an additional layer to deal with because other states ... they’re essentially using the Nevada model,” Korbulic said. “We want to be a good steward for other states.”
One potential issue during this year’s open enrollment, which Korbulic said isn’t unique to Nevada and its new system, is shifts in eligibility. She said that after processing the data it received from healthcare.gov, the exchange has determined that a significant chunk of current exchange enrollees are actually Medicaid eligible. The exchange has been working with the Division of Welfare and Supportive Services to ensure that those accounts are transferred and then run through a Medicaid eligibility check, she said.
“While that’s somewhat disruptive for a consumer who may have to shift from one [plan] to another, it is the right thing to connect people to the appropriate plan. You shouldn’t have to pay premiums if you’re Medicaid eligible,” Korbulic said. “Ultimately it will end up being a success story, but could be painful for the people in the middle who are trying to understand what is going on.”
Korbulic said that the exchange will be targeting most of its outreach efforts over the next 45 days on ensuring that the remaining 70 percent of enrollees claim their new accounts on the state platform, with a particular eye to those individuals whose plans will not auto-enroll whether they take action or not.
“Once we get live, we’ll be able to see who is auto renewed and not worry about those folks,” Korbulic said. “We’ll focus our energy and outreach efforts on the individuals who have not yet selected a plan and we’ll be sending email reminders and mail if necessary and then making outbound calls, I’m guessing, if we have the resources near the end.”
The exchange won’t be alone in this endeavor, either. It has trained and certified about 700 health insurance brokers to use the new state-based system to enroll people to plans.
(Nevadans will also for the first time be able to purchase a stand alone dental plan without having to purchase a qualified health plan through the exchange.)
The exchange will be open for enrollment from Nov. 1 through Dec. 15 at 11:59 p.m. For anyone needing assistance or experiencing issues with the website, the exchange is directing people to its call center, which will be open Monday through Friday and three Saturdays — Nov. 2, Dec.7 and Dec. 14 — from 9 a.m. to 5 p.m.
“There are going to be naysayers who see a glitch and immediately jump to the conclusion that that’s the case,” Korbulic said, referring to the issues with Xerox in 2013. “But we have to triage and temper our responses to, is this an issue that can be resolved quickly? Is it happening to only one person? Is it widespread? We have plans in place to deal with any kind of crisis, and we’re hoping our war room turns into a celebratory room.”