Hawaii Health Connector board members answered few questions at a public meeting Friday concerning the future of the troubled health insurance exchange.
It was the first Connector board meeting since Gov. David Ige acknowledged last week Hawaii is out of compliance with the federal Affordable Care Act and is at risk of losing $1 billion in Medicaid funds if Washington does not accept the state’s plan to remedy the ailing state-based exchange.
Ige’s administration confirmed Thursday that Hawaii is switching its Obamacare program to the federal exchange, meaning 37,000 Connector enrollees will have to re-enroll via the federal marketplace for coverage in 2016.
Board members were scheduled Friday to "discuss and approve" the administration’s plan to switch to the federal exchange for at least one year, according to the meeting agenda. The board tabled the discussion until Tuesday.
When one reporter asked what went wrong that the exchange couldn’t remain in state hands, Rachael Wong, director of the Department of Human Services and a Connector board member, said: "It is in state hands. That’s why I’m puzzled with your question. We’re in continued conversations with the federal agencies that oversee the Connector. Nothing’s a done deal."
Under the governor’s plan, the federal government and state would spend a combined $30 million to switch from the Connector to the federal exchange at healthcare.gov for one year.
That would buy the state time to bring the Connector into compliance with federal law, which requires the Connector be financially sustainable, resolve ongoing technology issues and be integrated with the Medicaid system.
When asked where the state is going to get the money to make the switch to the federal exchange, Wong said, "We’re in continued conversations with the federal agencies."
The state is negotiating with the federal government to release some of $70 million in grants originally targeted for use by the Connector, which was awarded $204.3 million in federal startup funds years ago. It has used about $130 million of those funds.
Jeff Kissel, the Connector’s executive director, said the organization will run out of cash by June 30 if the federal funds remain frozen. Federal officials want to see that the Connector has enough money to remain viable on its own before releasing more federal funds, Kissel said.
Use of the federal money is limited to information technology and outreach, Kissel said. Other operating funds must come from within the state.
A lack of funds is the main barrier to bringing the Connector into compliance with the ACA. After its launch in October 2013, the Connector was to fund its operations with a fee collected on each health insurance policy. To sustain operations, the Connector needed to enroll 70,000 members, but it has only 37,000 members.
Kissel asked the Legislature to help make up the shortfall by appropriating $5.4 million, but lawmakers granted the exchange just $2 million.
The governor’s plan to switch to the federal marketplace for one year has a high price tag.
It would require the state Department of Human Services spend $20 million to link its Medicaid eligibility system to healthcare.gov. Most of that would come from the federal dollars Medicaid receives. The state would need to put up another $10 million to $11 million to connect to the federal marketplace.
When asked how the state can justify spending an estimated $30 million of taxpayer money to connect to the federal exchange when lawmakers couldn’t even appropriate the full $5.4 million requested, Connector board chairman Clifford Alakai said: "We have no response at this time."
Alakai said the board also has not determined whether it will execute a separate contingency plan to shut down operations by Sept. 30 if the federal government doesn’t accept the state’s temporary fix.
"We’re still trying to figure it out," he said. "It’s not that easy."