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Faulty MNsure software never tested due to federal delays

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MNsure
Maureen O'Connell addresses people in attendance at the "MNsure Crash Course" Nov. 13, 2013, at the St. Paul Library to help them understand how federal health care reform affects their lives.
Jim Mone / AP

As technical problems with the state's online health insurance exchange pile up, MNsure announced today that it is giving people until the end of the year to enroll in a health plan.

But the eight-day extension may not be enough time to solve a series of bugs that have plagued the website for months. MNsure officials said the problems can be traced back to software sold to the state by a single vendor, IBM Curam, which was never tested by the state before officials bought it for millions of dollars.

The problems go beyond MNSure. IBM Curam's software was also supposed to ensure people enrolled in MinnesotaCare, a state subsidized program for the working poor, are eligible based on their incomes. However, the faulty software is making that impossible to determine.

The Affordable Care Act requires that the income verification system be in place by Jan. 1. But the state Office of the Legislative Auditor has warned that the system for other health programs, including MinnesotaCare, needs to be more streamlined to ensure that taxpayer money isn't going to people who don't qualify.

Chuck Johnson, deputy commissioner for policy and operations for the Minnesota Department of Human Services, is worried that his department will miss the deadline.

"Certainly the integrity of the program in terms of being able to ensure that those people who have the income that should make them eligible for the program are the ones who are receiving coverage through the program [is important]," Johnson said. "It's a serious concern for us that we're not able to verify that against an objective third-party source."

CASCADE EFFECT

MNsure's headquarters in downtown St. Paul has been inundated with consumer complaints since the website opened on Oct. 1.

Then, MNsure said that problems people had with the site and creating accounts stemmed from overuse and glitches with a federal database used to verify income.

But over the course of the next two months, consumers using the marketplace continued to have issues that are the result of faulty pre-packaged software made by IBM Curam, MNsure spokesman John Schadl said. The state is spending at least $3.9 million to license the programs.

Some customers who applied for federal subsidies or tax credits received bad information from the site, requiring MNsure to reevaluate 1,000 applications. Those applicants were asked to reapply.

Also, about 1,100 applications are stalled and Curam is still working to resolve the issue, Schadl said.

The glitches have led to a cascade of other consumer assistance problems at MNsure, Schadl said.

"These problems have caused frustrated and confused consumers to contact our call center in an effort to resolve their problems," he said. "That has caused significant increases in the wait times at our call centers."

IBM Curam did not respond to calls for comment. But the company did tell MPR News on Dec. 18 that it was "enhancing the performance of [MNsure] as quickly as possible."

UNVETTED SOFTWARE

Yet in 2011, when Human Services started vetting more than 10 potential vendors to overhaul its eligibility systems for Medical Assistance, MinnesotaCare and other programs like food and child support, Human Services' Chuck Johnson said IBM Curam was a standout.

"We thought that Curam had the strongest product for eligibility in the human services realm," he said.

But that's the not the same software that MNsure eventually bought.

"At the time, we didn't have - and nobody had - [IBM Curam's] health care reform package, which is the module that is now part of MNsure," Johnson said. "So that was not a piece that we had the ability to vet at the time."

That's because the product wasn't finalized until the summer of 2013, when rules laid out in the Affordable Care Act were completed.

IBM Curam's software is "essentially a rules engine, designed to make calculations based on the federal regulations that were being written to implement the ACA," said MNsure's John Schadl.

"With the exception of Massachusetts, there were no state exchanges running at the time of this request for proposals, so there was no way to check the track record of any of the software products under consideration," Schadl said. "There was also no way to test the rules engine, because the rules necessary to writing the final software did not all exist."

While the Minnesota Human Services Department and MN.IT, the state's information technology department, were part of the process of picking a vendor, it was MNsure — then part of the Department of Commerce — that made the final selection. All parties involved in the process agreed on the selection of IBM Curam, said Schadl.

Now, the human services department is grappling with its own set of problems stemming from the IBM Curam software.

At least 3,500 applications are being hand-entered because the program isn't able to transfer client information correctly to the state, Johnson said, and it has led to a backlog.

IBM Curam's software is also unable to verify income for about 9,000 MinnesotaCare applicants, a problem Johnson said he thought had been fixed in mid-November, but remains an issue today.

Not everyone who has applied for public programs has had problems, Johnson said. Roughly 30,000 people have successfully enrolled in MinnesotaCare and Medical Assistance, he said. 

Last March, Legislative Auditor Jim Nobles scolded DHS for not adequately verifying the eligibility of MinnesotaCare and some of its public assistance programs. Nobles summed up his concerns in two words: "errors and fraud." At the time, DHS responded that the income verification problem would be solved through MNsure's site.

IBM CURAM COMES TO ST. PAUL

After he learned about the problems with IBM Curam's software, Gov. Mark Dayton last week called the company personally and asked that it send its best workers to St. Paul to fix the problems.

It was just days before April Todd-Malmlov, MNsure's former Executive Director, submitted her resignation.

With the new enrollment deadline of Dec. 31 looming, IBM Curam employees are hunkered down at MNsure headquarters working to fix the site's ongoing problems.

Interim Executive Director Scott Leitz points out that roughly 40,000 people have been able to get insurance through the site, so not everyone is having problems.

And while Leitz said he's not sure if MNsure ever considered getting rid of IBM Curam under Todd-Malmlov's leadership, the organization should leave its options open in the future.

"Right now what we're doing is really trying to address what's there and make the current system work as best as we possibly can," he said.

For her part, Department of Human Services Commissioner Lucinda Jesson hopes things at MNsure are getting into place to turn a corner.

"Having the vendors on the ground working diligently with us on these issues, having new leadership, having an additional week for people to sign up for insurance that will be effective in January - those are all good signs," she said.