Hawaii Health Exchange Profile
Establishing the Exchange
On July 11, 2011, Governor Neil Abercrombie (D) signed SB 1348 into law establishing the Hawaii Health Connector,a state-based health insurance exchange. The law builds on Hawaii’s Prepaid Health Care Act of 1975 (PHCA) which required nearly all employers to provide health insurance to employees working 20 or more hours a week for four consecutive weeks.
Structure: The legislation established the Hawaii Health Connector as a non-profit corporation.
Governance: Governance: Beginning on July 1, 2012, the Connector transitioned from an interim board to a final 15-member board appointed by the Governor and with the advice and consent of the Senate. Four non-voting ex officio members (or their designees) are the Director of Commerce and Consumer Affairs, the Director of Health, the Director of Human Services, and the Director of Labor and Industrial Relations.
Current appointed Board members are:
- Hardy Spoehr (Chair), Papa Ola Lokahi
- Sherry Menor-McNamara (Vice-Chair), Chamber of Commerce of Hawaii
- Cliff Alakai (Treasurer), Maui Medical Group
- Gwen Rulona (Secretary), UFCW Local 480
- Clementina Ceria-Ulep, Faith Action Community Equity
- Joan Danieley, Kaiser Foundation Health Plan, Inc.
- Jennifer Diesman, Hawaii Medical Services Association
- Michael Gleason, The Arc of Hilo
- Robert Hirokawa, Hawaii Primary Care Association
- Faye Kurren, Hawaii Dental Service
- Christine Mai`i Sakuda, Hawaii Health Information Exchange
In December 2011, the Interim Board hired an Executive Director.
The Connector’s bylaws require the development of five standing committees: Audit and Finance, Legal Policy, Data Access and Technical Infrastructure, Community Outreach, and Community Advisory. The Interim Board also voted to create a standing Individual and Employer Consumer Advisory Committee in April 2012 and the permanent Board voted to create a Governance Committee in July 2012.
In May 2012, the Connector issued conflicts of interest policies, building on those set by the Interim Board in the previous year. The policies require that employees and Board Members of the Connector recuse themselves from any decision or discussion in which they believe they have a conflict of interest.
Contracting with Plans: The Connector will serve “as a clearinghouse for information on all qualified plans and qualified dental plans listed or included in the Connector.” The decision to operate the Connector as a clearinghouse was reaffirmed in November 2012, though the question will be revisited if there are additional entrants to the insurance market. In addition, the Insurance Commissioner will retain full regulatory jurisdiction over plans and determine inclusion eligibility, provided that all qualified health plans (QHPs) that apply are included in the Connector.
In December 2011, the Interim Board recommended that insurers offering qualified health plans (QHPs) through the Connector’s small group market should be required to offer QHPs through the Connector’s individual market. The Insurance Commissioner should be empowered to grant waivers to insurers able to demonstrate that compliance with this requirement would increase the risk of insolvency or financial hardship. In addition, insurers offering QHPs through the Connector should be required to offer the plans to all consumers in all geographic areas of the state.
The Connector anticipates requesting that issuers indicate their intent to submit QHPs by February 2013. The following month, issuers will begin submitting QHPs for qualification by the Department of Commerce and Consumer Affairs and for certification by the Connector. By July, the Connector’s review and certification process for the 2014 plan year will be complete. QHPs will be posted on the website as early as September and open enrollment will begin on October 1.
Risk Adjustment, Reinsurance, and Risk Corridors: Hawaii intends to use federal government services to administer its risk adjustment and reinsurance programs.
Consumer Assistance and Outreach: The Connector initiated an outreach effort to build relationships with community members, contact hard-to-reach populations, and identify where additional resources will be needed. In December 2012, the Connector procured subcontractor assistance with market research, development of a communication strategy (including public outreach and educational materials), and public relations.
The Connector has also begun planning for a call center that focuses on the exchange and transfers questions related to Medicaid and the Children’s Health Insurance Program (CHIP) to an existing call center within the Department of Human Services (DHS). It is possible that the functionality of the two call centers will be combined at a later date. The Connector has left open the possibility of asking the winner of the information technology RFP to establish the call center that would respond to requests from individuals, employers, employees, Navigators, and brokers.
The Interim Board recommended that Navigators should be restricted to nonprofit organizations in Hawaii in order to avoid conflict of interest. Insurance producers should be prohibited from serving as Navigators. However, in recognition of the role that insurance producers play in the state regarding the sale of insurance products to small business owners, insurance producers should be allowed to sell insurance products available through the Connector.
Small Business Health Options Program (SHOP) Exchange: In November 2012, the Connector confirmed that the definition of a small business is 100 or fewer employees. In addition, the Connector has been in communication with other state agencies and the federal government to integrate current law requirements in Hawaii, specifically the PHCA, with compliance with the ACA.
The Board also discussed the need for a feasibility study to determine the impact of outsourcing SHOP premium aggregation versus maintaining that function in-house. The Connector does not plan to perform premium aggregation in the individual exchange, unless it is demonstrated that there are cost efficiency benefits.
Information Technology (IT): On April 20, 2012, the Connector procured subcontractor assistance with the first phase of IT development, including project management and development of a concept plan for the IT system and architecture. In May, the Connector held Joint Application Development (JAD) sessions with multiple state agency and stakeholder groups to discuss a second IT RFP, which was released in July. This RFP includes implementation, maintenance, and operation of the enterprise exchange system suite of software and services for both the individual exchange and the Small Business Health Options Program (SHOP) exchange. The contract was awarded at the end of 2012 and extends over four years, after which operations will likely transfer gradually to the Connector or possibly another bidder. An RFP for Independent Verification and Validation of the Exchange project was released on October 29, 2012, and awarded the following month.
Previous assessments of Hawaii’s current technical infrastructure concluded that the state could not host an integrated IT solution and still meet federal deadlines. For that reason, bidders have been requested to plan a system that interfaces with the federal and state eligibility systems and databases, as well as with issuers of insurance plans. Specifically, the Connector will exchange data with the DHS’ eligibility system, which will be responsible for determining eligibility for Medicaid, CHIP, premium and cost sharing subsidies. The state is procuring assistance with replacing the existing DHS eligibility system, called the Hawaii Automated Welfare Information System, separately from the Connector’s IT RFP. The new DHS eligibility system is expected to be scalable and flexible in order to support other public programs, such as the Supplemental Nutritional Assistance Program (SNAP) and Temporary Assistance to Needy Families (TANF). To assist in financing the information technology upgrades of the state’s Medicaid eligibility systems, Hawaii applied for and received CMS approval of an Advanced Planning Document to receive enhanced federal funding.
The Hawaii Insurance Department (HID) and Hawaii Department of Commerce and Consumer Affairs (DCCA) will be responsible for certification and qualification of the QHPs. The HID currently uses the System for Electronic Rate and Form Filing (SERFF), an IT system that contains information about the health insurance issuers, rate, plans, and provider networks. The Connector’s IT system is expected to interface with the SERFF system.
Essential Health Benefits (EHB): The Affordable Care Act requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through an exchange, cover certain defined health benefits. The Governor’s office partnered with the DCCA and DHS to examine possible EHB plans and collect feedback through two public forums. On October 1, 2012, the Governor announced that the state had selected the HMSA Preferred Provider Plan 2010 as the EHB benchmark.
The Hawaii DCCA received a federal Exchange Planning grant of $1 million. In November 2011, the DCCA awarded a Level One Establishment grant of $14.4 million to create a web portal for the Connector. In August 2012, the Department of Health and Human Services was awarded a second Level One Establishment grant of $61.8 million to support outreach efforts, design and develop IT architecture and engage a quality assurance The Connector requested that the federal government reassign the grant money, originally provided to the DCCA.
The Connector may apply for other grants and receive funding from other public or private sources. In addition, the state may decide to appropriate money to the Connector. The Connector may also charge participating plans assessments or user fees.
On January 3, 2013, Hawaii received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a state-based exchange. Final approval is contingent upon the state demonstrating its ability to perform all required exchange activities on time, complying with future guidance and regulations, submitting a timeline mapping policy and technical decisions, developing memoranda of understanding between the Connector and other state partners, and developing and activating a contingency plan for eligibility and enrollment functions should the Connector be unable to demonstrate the ability to perform these functions with the existing plan by the end of January.
The Hawaii Health Connects website is http://hawaiihealthconnector.com/.