Since our last update, CMS has announced that it was delaying the online web enrollment portal for the FF-SHOP until November 2014 and instead encouraging small employers to purchase health insurance “through an agent, broker, or insurer that offers a certified SHOP plan and has agreed to conduct enrollment according to HHS standards.” However, employers will still be able to use HealthCare.gov to create an employee roster to view their plan choices, compare plans and get a cost estimate. For more details on the process, CMS has posted an FAQ with additional information.

On Sunday, HHS released a HealthCare.gov status report indicating that the agency had met its November 30 deadline for fixing many of the major issues that plagued the website at launch. The report noted hundreds of software and hardware fixes and increased capacity to host more users on the site at one time and up to 800,000 visitors per day. Finally, more than 12 dedicated servers were deployed to enhance the capacity and increase the speed of the website. These improvements were quickly tested, as website use spiked on Monday morning. By noon, approximately 375,000 users had visited HealthCare.gov, which CMS Communications Director Julie Bataille said is "roughly double" the normal number of users on a Monday. There were so many visitors to the site that HHS enabled an online "queuing" system to limit the number of users on the site. On Friday, CMS reported that a total of 3.7 million people visited the website this week without any unscheduled outages. CMS announced that from Monday through Wednesday of this week, 56,000 people have enrolled in a health plan. CMS also reported that it fixed a problem that had caused 80 percent of the errors carriers had complained about with the 834 enrollment files they were receiving. It’s unclear if the 834 fix has cleared up the issue for carriers completely, but today CMS disclosed that roughly 25 percent of the 834 enrollment files sent beginning in October contained errors. CMS now estimates that only 10 percent of the enrollment files sent by HealthCare.gov to carriers now contain errors.

CMS also announced a new payment system for carriers receiving APTC and CSR. Because the system to reconcile the differences between CMS's enrollment records and a carrier’s enrollment records has not been built and tested, CMS will rely on carriers to submit their enrollment records and estimates of what they are owed for CSR and APTC. Those estimated sums will be reviewed by CMS for reasonableness before being paid to carriers in January and will be reconciled at some point in the future when confirmed enrollment data is available.

Shifting to the states, many of them have reported increasing applications and enrollment numbers since we last checked in. On Tuesday, Covered California reported that it had received 431,756 applications as of Nov. 30. And on December 4, Connect for Health Colorado reported that it enrolled over 1,000 persons in one day, bringing total enrollment in private insurance by the exchange to over 10,000. MNsure also reported that enrollment had risen to 4,478, a significant increase over the 1,774 that had enrolled as of November 2. Connecticut also posted new enrollment numbers on December 5, stating that 23,440 had enrolled in health coverage, with 9,075 of that total qualifying for Medicaid or CHIP. The remaining 14,000+ persons have enrolled in private health insurance, with 62 percent of them selecting plans offered by Anthem Blue Cross and Blue Shield.

On the other side of the enrollment process, some states are still scrambling to enroll applicants in time for coverage on January 1. In Maryland, despite significant issues with the online web enrollment portal, the exchange has been able to enroll 3,024 people in private health insurance, though the exchange still has to process over 8,500 paper applications. To help boost capacity on hand, the Maryland exchange has added 40 workers to its 125-person call center and refocused its IT team to correcting issues that will improve user experiences and prevent bugs that appear during the final stages of the online enrollment process. For example, some applicants at the very end of the application and plan selection process have experienced a bug that prevents them from clicking the “enroll” button. Wednesday was a busy day for Cover Oregon call center workers as they dealt with high call volumes since it was the last day for applicants to submit their application to Cover Oregon to guarantee health coverage on January 1. To do so, applicants had to submit online or mail in their application for an eligibility determination no later than December 4. Once applicants receive their eligibility determination in the mail from Cover Oregon, if they qualify for enrolling in a QHP, they have until December 15 to select a plan, notify Cover Oregon of their choice, and pay their premium to their insurer by December 31. Persons that submit their plan choice after the December 15 will not have their health insurance go into effect until February 1, 2014 at the earliest.

On the IT end, two state exchanges announced significant upgrades to their systems. Covered California launched its online SHOP enrollment portal which allows employers to receive an online quote, submit an online application in real time, and the ability for employers to initiate electronic open enrollment for their employees. On the other side of the country, Vermont Health Connect announced that it was now ready to perform premium processing for individual and family policies. The exchange plans on mailing invoices to enrollees beginning this week and customers need to have their check in the mail back to the exchange by no later than January 7 for retroactive coverage. In the future, customers will be able to pay their premium online using a credit card, but the exchange chose to delay that function to allow additional time for security testing. Vermont is not the only state that has a payment due date after January 1. Enrollees in private health plans using the Maryland exchange have until January 15 to pay their insurance premium.