The state temporarily suspended its online Medicaid eligibility system over the weekend amid continuing problems with the technology that is set to cost taxpayers as much as $144 million.
The state Department of Human Services, which manages Medicaid in Hawaii, contracted information technology developer KPMG LLP in 2012 to build an online system intended to automate the Medicaid application process and determine eligibility in real time.
The system, known as Kolea, was launched Oct. 1, 2013, and more than a year later workers at 14 community health centers said it constantly freezes, frequently loses applicant information, doesn’t update eligibility in a timely manner and is unable to upload documents required for verification.
"That whole system is going to be a huge money hog," said Sen. Roz Baker, (D, West Maui-South Maui). "I do not know what Kolea is designed to do and why we are spending hundreds of millions of dollars, even if it’s federal money, on a system that’s not able to help us."
Lucrative technology contracts are prevalent across state departments. They often cost taxpayers hundreds of millions of dollars, are difficult to monitor and lead to trouble-plagued systems.
Problems at the state’s Medicaid program, which provides medical coverage for the low-income population, are reminiscent of the difficulties encountered by the Hawaii Health Connector, the Obamacare health insurance program for those with incomes too high to qualify for Medicaid.
The Connector was awarded $204 million in federal grants to build an online exchange that failed to open on time and frustrated users for months after it did launch. The Connector was built largely by contractor CGI Group Inc.
"The past year has brought significant scrutiny to Hawaii’s health insurance exchange, the Connector," Robert Hirokawa, head of the Hawaii Primary Care Association, wrote in his testimony to lawmakers examining Medicaid at a state Capitol briefing last month. "While we understand the challenges that the Connector has undergone, and the attention it has received, we must bring to the committee’s attention the extraordinary challenges that we have had with the state’s new Medicaid eligibility system."
Hirokawa’s organization lobbies on behalf of community health centers, which rely heavily on Medicaid to fund their care of low-income residents. Health center workers say the Kolea system has caused delays in Medicaid enrollment, hurting their ability to get paid for their services.
"This process and subsequent delays in getting coverage is not just frustrating for us," Leinaala Kanana, director of community health services at the Waianae Coast Comprehensive Health Center, said in written testimony to the Legislature. "Imagine the impact felt by someone who suffers from a chronic condition and needs a constant supply of medication or the young mother who’s strapped with mounting medical bills from the brief time in her newborn’s life prior to getting Medicaid coverage."
Interviews with the staff at community health centers over the past six months by the Hawaii Primary Care Association showed the Kolea system has consistent problems and that communication with the Department of Human Services has been "poor and sometimes hostile."
The DHS has touted Kolea as a significant improvement to the Medicaid program, resulting in faster enrollments.
"As of November 2014, Kolea has been used to make eligibility determinations for 134,000 applicants and redetermine eligibility for 341,000 beneficiaries," the DHS said in a recent memo. "Overall, 39 percent of applications have been submitted online and more than 25,000 applications have received a determination in less than 24 hours."
House Health Committee Chairwoman Della Au Belatti (D, Moiliili-Makiki-Tantalus) said DHS officials have repeatedly told lawmakers Kolea is working, contrary to the mounting complaints from the community.
"We have always been concerned eligibility is taking too long and it’s not a real-time system," she said. "We’re very concerned about Kolea and about the tremendous amounts of money that’s already been spent on the system."
The Kolea contractor, KPMG, didn’t return a call seeking comment. The DHS said that as of December it had spent $96 million of the $144 million contract with KPMG.
Kolea was taken down for five days starting Thursday and is scheduled to be back up at noon Monday to "improve program integrity and help eligible individuals obtain and maintain health care coverage with greater ease," the DHS said.
Those fixes might address some of the many problems encountered by health professionals, including complaints that they are often unable to log in to Kolea when submitting applications for patients and have no way of contacting the DHS directly for help. If they are able to get through, the process can take as long as an hour to complete.
"Unfortunately, ongoing barriers such as a poorly functioning electronic application system and lengthy application process make it difficult for patients to become enrolled in an efficient and timely manner," Dana Alonzo-Howeth, executive director of Maui’s Malama i ke Ola Health Center, told lawmakers. "My staff continues to express extreme frustration with the time wasted in navigating the Kolea system, redoing electronic applications altogether or resorting to completing applications manually due to these ongoing technical problems. These are particularly frustrating issues when they are trying to assist numerous patients a day who rely on them for help."
KPMG was first contracted in 2012 to build Kolea in concert with the Hawaii Health Connector to provide residents access to subsidized health insurance through Obamacare. However, the two systems have not been integrated, which resulted in a backlog of 11,000 Connector applicants last year and low enrollment for the exchange.
The DHS said the scheduled Kolea upgrades will improve automation of the eligibility process and the user experience.
"Beginning Monday, new online applicants also will be able to view their application status, eligibility determination, verification information and (DHS) notices," DHS spokeswoman Kayla Rosenfeld said in a news release. "Additionally, applicants and beneficiaries will be able to upload supporting documents and to report changes in circumstances."
Changes include an online application that closely resembles the paper form, and improved system access so workers can easily make redeterminations, the department said.
"We hope that the new phase of Kolea set to be released on Monday will fix the current problems and allow outreach workers to assist their clients gain much-needed health insurance coverage," Hirokawa said. "A functioning Medicaid eligibility system is essential to provide health care to our most vulnerable patients."
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ABOUT KOLEA
The state’s new Medicaid online application system:
>> Cost: $96 million spent to date of a $144 million contract
>> Contractor: KPMG LLP
>> Dates: Contract issued December 2012; system launched October 2013
SYSTEM’S FAILURES
Problems reported last month by community health centers:
>> Red error banners occur frequently with no explanation and cause all previously entered information to be lost.
>> Save and exit button does not work.
>> Cannot upload documents required for verification, which means you can partially apply online but need to fax or hand-deliver documents.
>> Fax is busy for half a workday or more.
>> Staff communication is poor and sometimes hostile.
>> There is no way to directly contact IT for support.
>> When you call, the staff refers you to a Medicaid number that is a recorded telephone menu that ultimately loops you back to the number you just called.
>> Front-line staff who answer phones aren’t always equipped to answer questions or provide follow-up, or don’t have the authority to make decisions; and there is no alternative person to speak with.
Source: Department of Human Services, community health centers
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