Value for State Based Exchanges to Adopt a Mobile Enrollment Strategy

If you’re a state using the Federal Facilitated Marketplace, allow me to share the fastest most effective way to ensure your consumers are eligible for a tax credit; leverage a mobile solution.

 

Tax credits for Federal Marketplaces Gone

There are 37 states that choose the Federal Facilitated Marketplaces (FFM) for their residents to purchase health coverage. These states are now in a tough position given the recent decision by the U.S. Court of Appeals for the D.C. Circuit striking down tax credits in federal exchanges.

 

These states risk losing out on $36.1 billion in insurance subsidies for 2016 according to the July 2014 article titled, ‘Halbig v Burwell: Potential Implications for ACA Coverage and Subsidies’ from the Urban Institute. This could cause an estimated 7.3 million people, about 62 percent of the 11.8 million people estimated to be enrollment by 2016, to miss out on insurance subsidies. Consumers in Texas and Florida are the most severely impacted with $5.6 billion and $4.8 billion respectively at risk.

 

Moving from Federal Exchanges to State Based models

FFM states do have the option of moving to a State Based Marketplace to ensure their consumers are eligible for insurance subsidies. Actually, several states have reached out to leading State Based Marketplaces seriously inquiring, in the feasibility of standing up their own SBM and tapping proven leadership experience both operationally and technically to help lock in success early.

 

For some states this is a great model and essential to their state roadmap. For other states the time and resources required might push this option closer to not feasible, given the complexity and cost. Historically the costs of successful State Based Marketplaces (SBM) have ranged from about $133 million to 1 billion; this is not a cheap endeavor. In addition to the significant cost outlay come extreme complexities around people, process and technology there are external obstacles including sleep political challenges that also must be overcome.

 

Low Cost, Short Timelines and Immediate Tax Credit Eligibility

What if there was another option? It’s called ‘Mobile Enroll.’ The Connecticut Health Insurance Exchange, Access Health CT, deployed the first state based marketplace mobile application of its kind! First rolled out in June 2014 no other state has a mobile product with these abilities as of November 23, 2014:

  1. SHOP (only state with a product to view plan and plan details in pre-screening)
    • To pre-screen individuals and families for:
      • Advanced Premium Tax Credit (APTC, discount from the consumer’s monthly payment)
      • Cost sharing Reductions (CSRs, lowers the amount a consumer has to pay out-of-pocket for deductibles, coinsurance, and copayments)
      • Medicaid
      • Children’s Health Insurance Program (CHIP)
    • Explore health plan options and view plan detail
    • Allow people to create an account to jump start the application process
  2. ENROLL (only state with a product actually enroll in a plan)
    • Fully enroll in Qualified Health Plans online
  3. VERIFY (only state with a product to upload verifications on a mobile device, fully integrated with existing back-end systems)
    • Allow customers to submit verifications documents using their camera on their mobile device
    • Enable customers to view their messages, uploaded documents, and notices

 

Targeted for November 2014 is Phase 2 which includes the ability to fully apply and enrollment for benefits using the mobile application downloaded for the iPad from the iTunes Store or the Android Tablet from the Google Play Store.

 

Fast speed to market and low total cost of ownership make choosing a state run mobile solution is sound decision.

 

Leveraging a proven mobile solution framework simply makes sense for many states looking to immediately ensure their consumers are eligible for a tax credits.

 

Connecticut has done this well and you can preview their mobile splash page at https://www.ahctmobile.com/.

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Peter is a healthcare business and technology executive, recognized for Digital Innovation by CIO 100, MIT Sloan, Computerworld, and the Project Management Institute. As Managing Director at OROCA Innovations, Peter leads the CXO advisory services practice driving digital strategies. Peter was honored as an MIT Sloan CIO Leadership Award Finalist in 2015 and is a regular contributor to CIO.com on innovation. As Head of Information Technology, Peter was responsible for Connecticut’s Health Insurance Exchange’s (HIX) industry-leading digital platform transforming consumerism and retail oriented services for the health insurance industry. Peter championed the Connecticut marketplace digital implementation with a transformational cloud-based SaaS platform and mobile application recognized as a 2014 PMI Project of the Year Award finalist, CIO 100, and awards for best digital services, API, and platform. He also received a lifetime achievement award for leadership and digital transformation, honored as a 2016 Computerworld Premier 100 IT Leader. Peter is the author of Learning Intelligence: Expand Thinking. Absorb Alternative. Unlock Possibilities (2017), which Marshall Goldsmith, author of the New York Times No. 1 bestseller Triggers, calls "a must-read for any leader wanting to compete in the innovation-powered landscape of today." Peter also authored The Power of Blockchain for Healthcare: How Blockchain Will Ignite The Future of Healthcare (2017), the first book to explore the vast opportunities for blockchain to transform the patient experience. Peter has a B.S. in C.I.S from Bentley University and an MBA from Quinnipiac University, where he graduated Summa Cum Laude. He earned his PMP® in 2001 and is a certified Six Sigma Master Black Belt, Masters in Business Relationship Management (MBRM) and Certified Scrum Master. As a Commercial Rated Aviation Pilot and Master Scuba Diver, Peter understands first hand, how to anticipate change and lead boldly.