States health exchanges still face uncertainties
States are building the infrastructures for integrating their exchanges with federal systems, but a federal data services hub for sharing the information remains a bit of an unknown, GAO says.
States are making progress connecting their own health exchanges with federal agencies, according to a recent report from the Government Accountability Office. But among the remaining challenges is that a federal data services hub to be used for exchanging information isn’t finished yet.
States are charged with fully activating their choice of health exchange by Oct. 1, 2013, the date set for the launch by the Affordable Care Act. GAO looked at seven states whose exchanges are in various stages of development but which are expected to be completed by the deadline.
According to GAO’s report, all seven states surveyed are developing IT infrastructure that includes upgrading or replacing their outdated Medicaid and Children's Health Insurance Program eligibility and enrollment systems. In addition, six of the states are building not only the Web interface for consumers to navigate health options but also the infrastructure needed to integrate the exchanges with federal systems to determine applicant eligibility.
The state systems are expected to tap into a federal data services hub provided by the Health and Human Services Department that will serve as a single source of the federal data that determines eligibility. State systems will transmit requests for data through the hub to multiple federal agencies, including the Homeland Security Department, IRS, Social Security Administration and Veterans Heath Administration, to name a few. The hub then returns the data in near real-time back to the states, where it can be used to verify the applicants’ eligibility.
GAO acknowledged the complexity of the task: "With the amount of data that states must share with HHS in order to verify eligibility, developing streamlined eligibility and enrollment systems is a vast undertaking requiring states to develop sophisticated IT systems."
Unfortunately for states, the federal data services hub is also under development (as are the rules governing its use), so the challenge for states is to build in enough flexibility so that the systems can communicate when they are finished.
Additionally, because tax and income information will be transmitted, “there is a laundry list of privacy and security standards that must be met,” according to Dylan Scott’s blog post on Governing. Further, Scott said, “the IRS is accustomed to receiving and then processing this kind of information over long periods of time, up to a month, while the exchange is supposed to provide verification in almost real-time. Nobody is sure if and how the hub will be equipped to handle that workload.”
Officials in six states surveyed told GAO that even though they did not have complete information on the requirements of the federal data services hub, they still needed to begin working on their end of the IT infrastructure. For its part, the Centers for Medicare & Medicaid Services has released guidance to the states on how to access or verify data through the federal data services hub through such sources as webinars, conferences and other forums. Still, most state officials told GAO they were concerned that the lack of specific IT-related federal guidance could lead to changes late in the development process.
Stan Czerwinski, who headed the group that authored the GAO report, told Governing that states will likely be working on the plugging into the federal exchange up to and following the deadline. “Until they're able to do this testing to make sure that all these points connect, it's still unknown,” Czerwinski says. “I think they agree that it's the biggest challenge area and will need adjusting from day one.”