The past week has been a flurry of announcements by HHS, State-based Exchanges and insurance carriers as we move into the final days for most shoppers to purchase a health plan that begins providing coverage on January 1. Let’s dive in.

Starting at the federal level, CMS disclosed over the weekend that it estimates that between October and late November, there were only 15,000 enrollment files that were never sent to carriers. These “orphan” enrollments occur when a HealthCare.gov customer clicks the “enroll” button, but HealthCare.gov never transmits the file to the carrier. CMS now reports that orphan enrollments are only occurring less than 1% of the time and that the 834 files sent to carriers have dramatically fewer errors. On their end, carriers are busy comparing the CMS pre-audit files against their records to not only ensure that everyone that signed up for coverage using HealthCare.gov matches CMS records, but that the carriers have all the necessary information they need. While carriers generally say the data quality of HealthCare.gov’s 834 files has improved, others still report receiving duplicate enrollment files or files with incorrect names, addresses or family affiliation information. 

There are also anecdotal reports of occasional quirks manifesting during HealthCare.gov’s subsidy evaluation period. In one quirk, for a low income family of five, the parents qualify for tax credits and two of the children qualify for CHIP, but the third child fails to qualify for CHIP or a tax credit. In other situations, certain higher-income earners mistakenly qualify for Medicaid instead of APTC and cannot purchase a subsidized health plan until they appeal HealthCare.gov’s preliminary Medicaid eligibility determination.

Also this week, CMS informed carriers that its pilot program testing of Direct Enrollment had yielded positive results. For their part, web brokers continue to report limited success with Direct Enrollment. Some web brokers have reported that they have not been able to reliably use the online pathway to determine whether an applicant was eligible for a subsidy, but earlier this week eHealth said that it had “completed a limited number of test enrollments through its web-based integration with HealthCare.gov to enroll subsidy-eligible customers.” However, eHealth has not found the process stable enough for general consumers to use. Next year, stay tuned to see how many carriers choose to begin using Direct Enrollment during the first quarter of 2014 and how many others choose to adopt it later in the year.

Rounding out federal developments, the IRS posted a notice outlining how small businesses that are not served by a State-based SHOP or the FF-SHOP can claim the SHOP tax credit. HHS also announced another option for persons whose insurance plans were canceled. Policy holders notified that their individual market policy would not be renewed now have the option of claiming the hardship exemption, which exempts them from the individual mandate to purchase insurance. Shoppers that fall into this category, but want health insurance, can purchase any of the exchange plans, including catastrophic coverage, or can choose to purchase an off exchange health plan directly from an insurers.

As we close toward the end of the year and run up against the December 23 deadline to enroll in a health plan for coverage beginning on January 1, 2014, the past week has been all about one thing: enrollment. At the national level, on Wednesday the Board of Directors for America’s Health Insurance Plans voted to give shoppers in the Federally-facilitated Marketplace until January 10 to pay for coverage beginning January 1, but the announcement still encouraged consumers to check with the plan they selected “for more details about their specific coverage policy.” Previously, new policyholders had until December 31 to pay their premium.

The federal government and national insurers are not the only companies that have announced new deadlines to provide more time to shoppers to enroll in coverage, many state exchanges have taken similar moves. Below is a non-exhaustive list of the delays and new due-dates that we’ve noticed:

California

Enrollment Deadline: December 23, 2013Payment Deadline: January 6, 2014

Connecticut

Enrollment Deadline: December 23, 2013Payment Deadline: January 7, 2014

Maryland

Enrollment Deadline: December 27, 2013Payment Deadline: January 15, 2014

Minnesota

Enrollment Deadline: December 31, 2013Payment Deadline: January 10, 2014

Oregon

Enrollment Deadline: December 27, 2013Payment Deadline: January 15, 2014

Rhode Island

Enrollment Deadline: December 31, 2013Payment Deadline: January 6, 2014

Washington

Enrollment Deadline: December 23, 2013 (To start an application)Payment Deadline: January 15, 2014

As for other activity in the states, it was a slow week policy-wise as many exchanges doubled down on activities to boost enrollment. On a Wednesday FamiliesUSA call, top exchange officials from California, Connecticut, Kentucky and New York, stated that enrollment had increased substantially in early December. Covered California says 50,000 enrolled during the first week of December, while AccessHealth CT said it was now reporting 1,400 enrollments a day. But as enrollment though State-based Exchanges cranks up, so does the need for support during the application process which has been manifested by many exchanges reporting rising call volumes at their call centers. Some exchanges, such as Covered California and Kynect, among others, have responded to increased call volumes by extending hours for their call center. 

Exchanges are also reminding recent enrollees to complete the enrollment process by paying their bill to carriers. Covered California has started an advertising campaign to remind recent enrollees to pay their bill. According to news reports, of the 110,000 that have enrolled in private health insurance, carriers have mailed out over 60,000 invoices, with few customers paying as of December 16.

Still, some state marketplaces continue to struggle, due in large part to ongoing issues with their web portals. In Massachusetts, where a well-functioning marketplace had been in place since 2007, only 1,400 people have signed up for new coverage due to technical glitches with the Commonwealth Connector’s revamped enrollment system. The revamp prompted the state to allow the 100,000 low-income individuals, who were to be transferred to the new system, to stay on their existing coverage through March.

On the IT end, over the weekend, Governor Martin O’Malley (D) announced that the bug-ridden Maryland Health Connection had taken major strides solving many of the IT problems plaguing the exchange. One of the bugs technicians focused on was a glitch that prevented some applicants from clicking the “Enroll” button at the end of the application and plan selection process. Following Governor O’Malley’s announcement, Navigators and brokers offered mixed reviews as to whether the Maryland Health Connection was running any smoother. As of Monday, the CEO of Evergreen Health Peter Beilenson said his agents were still experiencing problems with the site. As the exchange moves toward continuing to improve its user experience, this week the Maryland Health Benefit Exchange hired Optum/QSSI to provide project management and operational support.

And for this week’s final IT related update, the New Mexico Health Insurance Exchange chose to award an $18 million contract to Deloitte to link its forthcoming Individual exchange, which is being built by GetInsured.com, to the state’s Medicaid system.

Also this week MNsure Executive Director April Todd-Malmlov resigned her post. She becomes the fourth exchange leader to step down since October 1, with exchanges in Maryland, Oregon and Hawaii all seeing changes in leadership.