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IT Systems

Challenge Number One

The Information Technology (IT) challenge is the first obstacle to be faced because it requires the the most time to complete. The Exchange IT task is massive. An estimated 3.5 million Californians will be eligible for federal “tax credits” or premium subsidies to cut the cost of their health coverage when they begin buying policies through the California Health Benefit Exchange in 2014. An additional 1.9 million will qualify for expanded Medi-Cal coverage.

Enrollment IT Standards

In January 2014, with the full implementation of the Affordable Care Act (ACA), consumers will open one door at the California Health Benefit Exchange and it will lead them to Medi-Cal, Healthy Families, health insurance premium tax credits, exemptions from the mandate, and private coverage. By January 2014, policies, procedures and enrollment IT systems will need to support this new vision. To this end, while new eligibility rules and other operational policies are still being ironed out, the Secretary of Health and Human Services recently adopted a series of Enrollment IT Standards for use by states and federal agencies implementing ACA. The standards were mandated by Section 1561 of the health reform legislation, developed by a workgroup of stakeholders co-chaired by U.S. Chief Technology Officer Aneesh Chopra and California Healthcare Foundation Vice President Sam Karp, and are now posted on the web site of the National Coordinator for Health Information Technology. At a high level, the standards support the following vision:

  • All people have the opportunity to make informed choices about their health coverage and other benefits.
  • Consumers apply online, renew coverage online, and learn about final determination online.
  • Systems talk to each other and share and store information so consumers don’t have to provide the same information over and over again.
  • Information provided for one program is used to support consumers through their permission and direction in applying for other programs for which they may be eligible.
  • Consumers will be able to see data provided by federal verification systems and provide appropriate updates or information to validate their current situation.
  • Consumers will be able to download and re-use the information they provide for program eligibility for other purposes, similar to the Veteran’s Administration “Blue Button” approach.
  • The process is transparent and enables consumer participation, thereby reducing burden on everyone — including states and counties.

California’s Triple Threat

Bill Obernesser, IT policy adviser with the California Health Benefit Exchange, said, “Any state looking at the deadline has to say, ‘Do we have anything in existence that we can leverage?’” One of California’s biggest challenges in meeting the exchange deadline will be systems integration. “We have three eligibility systems for our public assistance programs, so I don’t think I or anyone else could imagine an exchange system that somehow doesn’t talk to that welfare eligibility system…” Obernesser said the state will likely hire some integration help in early next year to see how best to tackle those issues.

The Good News Is…

While it may seem overwhelming to imagine getting the California enrollment system from where they are now to where they need to be in 2014, the good news is current technology has the ability to handle connectivity and communication among different systems regardless of how they are built and how they function. Because California does not have the resources or time to rip and replace legacy systems to accommodate the changes required by ACA, learning about and implementing newer solutions for integration will be critical. That said, the clock is ticking and is important to begin assessing their systems against the standards that have been posted and learning about integration solutions now.

Return to Index of Challenges the Exchange Must Overcome

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