Insurers participating in the state health care exchange say they need to know soon whether there will be another extension of the enrollment deadline.

Representatives from the two insurance companies told lawmakers Thursday they need to know by late January or early February whether the March 31 sign-up date would be pushed back.

"It's not April 1st by which all this has to happen, people need to begin making their decisions much earlier than that," said Kevin Goddard, vice president for external affairs at Blue Cross and Blue Shield of Vermont.

Waiting beyond late January to begin another massive round of outreach to their clients - who are mandated under state law to enroll Vermont Health Connect plans - would be a serious problem, Goddard told the House Health Care Committee.

Blue Cross made 45,000 phone calls after the deadline was extended in November, he said.

MVP lobbyist Susan Gretkowski, representing the other insurer in the exchange, said her company, which has fewer exchange clients, needs that certainty by the first week of February.

Among the lingering concerns insurers have with the website are that small businesses can't use it, individuals can't pay with credit or debit cards and, perhaps most frustrating to everyone involved, users can't go back and make changes - such as adding a new dependent or giving a new address - to their online applications. Currently, changes have to go through customer service.

"Significant functions of Vermont Health Connect are either in initial testing or have not yet been tested," Goddard said.


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"Until we see that the system is tested and its functions work cleanly and efficiently we remain unsettled with large populations moving into (that system)."

DVHA Commissioner Mark Larson said he recognized the amount of work required by the insurance companies if there is another delay, but he could not say when the website would be fully operational.

"I think we have all have become very careful in being accurate in what we say," Larson said. "The governor has been clear about not giving absolute dates."

He said testing is ongoing and his office is in daily communication with the insurers.

Goddard said the parties are working collaboratively to find solutions, but he wanted to make his concerns clear to lawmakers.

If the deadline can't be met, and DVHA has to put in place additional contingency measures, Gretkowski said the state should allow the insurers to directly enroll the approximately 35,000 remaining Vermonters who need to be covered by Vermont Health Connect plans.

Blue Cross has directly enrolled 14,500 people through small business employers. Another 27,000 Blue Cross customers have opted to use the extension. Goddard said the state told the insurer that 12,000 people will be covered by Blue Cross once all the exchange applications are processed. Of those, Blue Cross has completed enrollment for 6,241 as of 8 a.m. Thursday, Goddard said. Another 15,000 Blue Cross customers elected to keep their existing plans.

Goddard's numbers don't correspond directly with those cited by the state, because he's using the total number of lives covered. When the state gives a figure such as 23,000 have signed up through the exchange, they're referring to policyholders, which could be an individual or a family of six.

MVP is working to put together similar numbers for its exchange enrollees, Gretkowski said, but she didn't have any to share with the committee Thursday.

One thing that's making extracting those numbers more difficult, Gretkowski said, is that Vermont Health Connect is withholding payment information until it has a significant number of accounts to send together, instead of sending each one to the insurer as it's cleared.

"It's not a situation where, when I pay my bill and my check clears they send that information immediately to us. They're holding it and sending it in batches," she said.

Clients, who aren't in MVP's database, are calling the insurer to say they've selected MVP and made a payment, but have yet to receive an ID card.

Trinka Kerr, the state's Health Care Advocate, said her office has received similar complaints from consumers who are having trouble telling if their checks have been processed.

Many have begun checking with their bank to see if a check clears, and it's taking as long as two weeks for that to happen in some cases. She gave one example of a woman who waited eight days for her payment to be processed before canceling the check for fear it was lost.

"I don't even know how that's going to be resolved," Kerr said.

Workers at the call center aren't able to access payment information to tell people whether their checks are processed, which exacerbates the uncertainty, she added.

"It's staggering to me that it's the third day (of testimony) and now we hear this rather significant snafu," said Chris Pearson, P-Burlington. He also expressed frustration that no DVHA officials were on hand to answer questions.

Another problem Kerr brought up is that people aren't receiving notices telling them what level of premium subsidies they qualify for. DVHA has said getting those notices out promptly is a priority, and they should start being delivered this week.

Kerr also worries about non-citizen legal residents who qualify for Medicaid but are having problems signing up through the exchange. Typically, immigrants have to be in the U.S. for five years before becoming eligible for Medicaid, but there are exceptions for refugees, those with asylum and victims of domestic violence.

The exchange does not differentiate between those immigration statuses, preventing those populations from accessing coverage, she said.

There is a temporary fix for them as of Wednesday, Kerr said, but they still can't sign up using the website.

The application requires immigrants to enter the expiration date of their green cards, but some cards do not have expiration dates. In some cases they've been forced to make up an expiration date to complete the online application, Kerr said.