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For thousands of users, promise of MNsure is always 'pending'


ST. PAUL — Cindy Kennedy let go of her health insurance last year based on the promise of subsidized coverage through MNsure, the state’s new health insurance exchange.

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She applied in October, but by the fourth week in January the MNsure system continued to list her application as “Pending.”

“I’m uninsured for the first time since 1992,” Kennedy wrote in an email to the Pioneer Press. Following one attempt to resolve the problem, “I cried for an hour in frustration.”

It took an intervention last week by state workers, but Kennedy now has health insurance through the state’s MinnesotaCare program.

But her confusion and frustration speak to the experience of others as the total number of pending applications in the MNsure system continues to increase.

Just because an application is pending doesn’t necessarily mean an applicant doesn’t have coverage, or won’t receive retroactive coverage in the future, state officials say. Even so, the situation worries advocates for people who are trying to obtain insurance through the new system.

“My fear is that some people are not going to be successful in getting the coverage, because they don’t know they need to do something more or they don’t know how to do what they’re being asked to do,” said Ralonda Mason, an attorney with St. Cloud Area Legal Services. “Clearly, the system is struggling.”

Minnesota launched the MNsure health exchange in 2013 to implement the federal Affordable Care Act, which requires almost all Americans to have coverage or pay a tax penalty.

People don’t have to use the health exchange, but it’s the only way for individuals to buy a commercial insurance policy with the help of a federal tax credit. The system also helps determine whether someone qualifies for MinnesotaCare or Medical Assistance, which is the state’s name for the Medicaid health insurance program.

By mid-January, more than 80,000 people had successfully obtained public or private health insurance coverage through MNsure. But as enrollment totals have grown, so has the number of pending applications.

At the end of December, more than 17,000 people were connected to pending applications within the MNsure system. By Jan. 24, the number had grown to 29,994, said John Schadl, a spokesman for MNsure.

“People might have some frustration or confusion because there are several definitions of pending,” said Rebecca Lozano, a health insurance navigator with Portico Healthnet in St. Paul. “It doesn’t necessarily mean there are that many people stuck in the system. I would assume that the vast majority of those folks just need to submit the extra verifications.”

Software concerns

Applications go into the pending file for a number of reasons, state officials say, and can broadly be categorized in two ways — those connected with MNsure software issues and those involving eligibility verifications.

For years prior to MNsure, verifying eligibility for government assistance could be a slow, confusing and frustrating process for consumers, Lozano said. As a result of the federal law, more people have access to government assistance, she said, so many could be experiencing those frustrations for the first time.

Navigators and state workers should be able to help make sure people get care while verifications are being worked out, Lozano said. When applications are pending due to problems with the MNsure website, navigators can help identify problems and get state officials involved.

“A lot of the issues and errors that people are experiencing could have been avoided or at least explained if people had help from someone,” Lozano said, adding that fewer applications now seem to be pending for software reasons.

One of those software glitches involves families where children are thought to qualify for the Medicaid program, but parents don’t. When more information is needed to verify that children qualify, coverage applications for the parents are wrongly being placed in a pending status, state officials say. The scenario was highlighted by Gov. Mark Dayton in a December letter to officials with IBM, which is one of four primary software vendors for MNsure.

“For people eligible for MinnesotaCare or (tax credits), the regulations require us to not delay eligibility,” Dayton wrote. “Just because someone else on the application may be eligible for Medicaid does not allow us to ignore that regulation.”

The backlog in pending applications has a lot to do with problems in software from IBM’s Curam division, said Schadl, the MNsure spokesman. Last fall, it was flaws in the Curam software, he said, that forced the state to manually process 30,000 applications.

The work “overwhelmed MNsure’s ability to respond and began a cascading series of events that led to significant backlogs in clearing pending cases, processing paper applications and responding to contact center inquiries in a timely manner,” Schadl said in a statement.