By Matt Murphy


STATE HOUSE -- With a federal extension now in place protecting existing health care coverage for 155,000 residents, officials tasked with fixing the state's much-maligned enrollment website are turning their attention to clearing the backlog of applications that must be processed manually to enroll new and existing subscribers in plans that comply with the Affordable Care Act.

Sarah Iselin, the governor's new special assistant in charge of overseeing the Health Connector website fix, told the Health Connector board on Thursday that the Centers for Medicare and Medicaid Services late Wednesday night approved the state's request to extend existing coverage plans beyond March 31.

Though the state requested a six-month extension, CMS gave Massachusetts until June 30 for now to get its enrollment project back on track. CMS Deputy Administrator and Medicaid Director Cindy Mann called Iselin to inform her of the decision, according to an Iselin aide.

The extension applies to 124,000 Commonwealth Care subscribers and 30,000 individuals who applied for non-subsidized coverage and have been put into a temporary coverage option. Another 25,000 applicants are expected to be enrolled in temporary coverage in February as they await permanent assignment to MassHealth or another subsidized or non-subsidized plan.



Deval Patrick last week appointed Iselin to oversee the project of repairing the Health Connector enrollment website designed by CGI that has failed to operate properly since it went live in October and is unable to guide consumers through the process of submitting an application, selecting a plan and completing their enrollment.

The information technology firm Optum has been brought in to assist CGI with the site fix, and to help Connector and MassHealth officials process applications using "workaround" solutions that don't rely on the website.

"The workarounds we have put in place are not working well enough, it's not reliable enough and it's not fast enough, which means we have to do more," Connector Executive Director Jean Yang said.

Iselin said there are currently 50,000 paper applications that have been submitted by consumers and scanned into a database that need to be manually entered into the enrollment system, requiring approximately two-hours of work per application. The Optum team is working with state officials to develop a new data entry tool that Iselin hopes will reduce the data entry time to about 30 minutes per application, but it is not expected to be ready for another three weeks.

In the meantime, 39 Optum employees are expected to arrive in Boston next week to assist with application processing and that number is expected to grow to 300 over the next few weeks. Iselin and the Optum team have established a command center at MassHealth offices in Quincy, but are expected to move into new office space in downtown Boston soon. The Executive Office of Administration and Finance is scouting potential locations.

Iselin's short-term strategy also involves making immediate progress to improve the customer experience on the website, including glitches that cause timeouts, random error messages, difficulty navigating from one page to the next and incompatibility with certain web browsers.

Iselin expects to deliver weekly public updates on Fridays to discuss the progress being made against short and long-term benchmarks for improving web performance and customer experiences as they work to develop longer term goals for building a fully functional web enrollment portal.

She said she cannot yet put a timetable on when to expect the site to be fully operational. To date, 8,400 individuals and families have been enrolled in ACA-qualified health plans and 30,000 new subscribers have been added to subsidized plans and 4,500 new enrollees have signed up for unsubsidized qualified plans.

Of the 32,000 members in Commonwealth Choice, who purchase unsubsidized plans with private insurers through the Connector, about 2,200 have been successfully transitioned to new plans. For the remainder who will lose coverage on March 31 unless they can navigate the system, Connector officials said the website, despite glitches, can be used to purchase unsubsidized plans or members can access a new "Fast Path" to coverage by selecting an ACA plan from their insurer that closely mirrors their current coverage and submitting a payment. Those plan options will be mailed to Commonwealth Choice members.

During her report to the board, Yang grew emotional as she discussed the hours her staff has been putting in to try to serve residents facing obstacles to accessing health coverage because of the technology problems. Choking back tears as she struggled to compose herself, Yang said her staff came to work for the Connector to be leaders in the health care field but are now "embarrassed to tell their family and friends they work for the Connector."

"The market cannot wait and people need help," she said. "That's what keeps me up at night."

Dolores Mitchell, a Connector board member, reassured Yang. "A shaky voice every now and then sends a powerful message about how much you care," Mitchell said. "You're going to get it right. I know you are."

After the meeting, Yang apologized for losing her composure, but said she doesn't want to lose members of her team over the IT debacle.

"I feel grateful to the people who are surrounding me and I just don't want to take any extra day for granted that they will continue to be here working on this because I think that's huge sacrifice on their part and we wanted to be very clear we're thankful for what they're doing every day. We need to repeat that every day," Yang said.

Connector board member Ian Duncan, who has publicly questioned the decision to build a new enrollment website from scratch, also took issue with blame being thrown at the board for the website's failures.

"There are people saying the board is culpable for falling down in its duty, and from my point of view that's not true," he told his fellow board members.

Duncan was referring to a memo written by board member Jonathan Gruber, which was reported on by the Boston Herald, in which Gruber suggested the board was so focused on policy and projecting a "harmonious image" that it was "falling down on our jobs." Though Gruber said he was one of the first offenders, the national health policy expert said all the blame shouldn't fall on CGI.

"It's his opinion, but I think one of my concerns about the board is our role with regard to that contract was never clear to me. We, I don't think, had oversight. It was a UMass contract," Duncan told the News Service after Thursday's meeting.

Though the Connector staff was involved in oversight and the board received regular updates, Duncan said, "There was nothing about those updates that suggested any kind of trouble until right toward the go-live date, so I think it's unfair to characterize us as a board as uninvolved. I certainly am not. I ask questions all the time."

He added, "I hope at some point when the dust settles we get to the bottom of what was done when and who was responsible for what because I don't feel like I really know. I have many questions."

Mitchell, the executive director of the Group Insurance Commission, said she didn't want to get into a tit-for-tat with Gruber and that the board should be prepared to answer questions about its role given the high-profile public nature of the website's shortcomings.

"Does he raise a legitimate point? Yes, I think he does. Do I totally agree with him? No, I don't," said Mitchell, adding that in her experience it is common for boards to be more focused on policy than administration.

Mitchell said she had complete faith in Yang as executive director of Connector and was impressed by how quickly Iselin has familiarized herself with the project.

"This was just one great big tsunami here, and I don't believe in throwing people to the wolves unless you find out they have done a job of incompetence or anything more serious than that. There's enough blame to go around, so I'm comfortable that we've got a good team," Mitchell said.