Forum Explores Other States’ Handling of Exchange, Medicaid Enrollment

Two months into the exchanges’ open enrollment period, California leads the country in exchange enrollment. In fact, after the first month, California had about one-third of the nation’s exchange enrollment.

But California is not the only success story. Other states have established robust exchanges and yesterday officials from some of them talked about what they’ve been accomplishing in their own exchanges.

“With Affordable Care Act-related enrollment, states have had nine weeks of experience,” said Catherine Hess, managing director for coverage and access at the National Academy for State Health Policy, a co-sponsor of yesterday’s online forum. “We thought it would be a good idea for them to share their experiences so far.”

Hess pointed out that a big part of the open enrollment period, among the states that have created exchanges, includes successful expansion of Medicaid — Medi-Cal in California.

“The number of Medicaid applications increased by 15.5% in the expansion states,” Hess said, “compared with a 4.1% increase in other states during the same time.”

Joanne Jee, program director for NASHP, said the shortcomings of the exchanges have been well-reported but successes have gone relatively unnoticed, such as the strong cooperation between exchange and Medicaid expansion officials.

“We have seen an incredible amount of work over a short period of time. Individuals are applying and they are getting coverage,” Jee said. “We hear a lot about glitches, but glitches can be fixed.”

That was the experience of Michael Koetting, deputy director of planning and reform implementation at the Illinois Department of Healthcare and Family Services.

“Our biggest success is we didn’t wait ’til Jan. 1 [2014],” Koetting said. “We had early enrollment for Medicaid, so this was really a big start for us.”

Keeping the goals reasonable was the key, said John Supra, deputy director for information management and CIO of the South Carolina Department of Health and Human Services. 

“We limited the scope of work so we could have success around it,” Supra said, and that online registration effort paid off for South Carolinans, he said. “In these first two months, about 70% have had success getting through what we set up. We were really happy to do what we did in October.”

In Washington state, one of the successes was the decision to allow people full access to the site without registering first, according to Richard Onizuka, CEO of the Washington Health Benefit Exchange.

“On our state-based exchange we allowed anonymous browsing,” Onizuka said. “So people don’t have to register or create an account to look at their choices.”

Washington state residents eventually did create 183,978 accounts, he said. “And that way, the accounts they created really mean something.”

That effort was helped enormously by a successful TV advertising campaign, Onizuka said. They were themed, “Don’t leave it to chance.”

“We had one ad featuring a snowboarder,” he said. “And Businessweek [magazine] called our raccoon ad the best health care ad in the country.”

Koetting said Illinois was lucky in that it received a federal outreach grant. “So we had a substantial media campaign — TV, radio, print, events … and a robust social media campaign,” Koetting said.

“The key to our process is to think of it as one-stop shopping and driving everyone there with a single website, a single phone number, then we get them sent to the right place,” Koetting said.

Koetting said being flexible in terms of planning has made all the difference.

“The boxer, Joe Louis, he’s attributed as saying, ‘Everybody’s got a plan, [until] they get hit,’ ” Koetting said, referring to the flurry of negative media reports and website malfunctions that marked the first month of open enrollment.

“The important thing we learned,” he said, “you do what you can get done. Don’t try to do everything all at once, and don’t promise that you can do it all at once.