Eligibility determination has been the big problem. That's the website function that calculates whether an applicant qualifies for Oregon's expanded Medicaid program, or for federal premium subsidies for private plans. “It was not working properly and is still not working properly,” Holm said.
Oracle is Oregon's contractor for the development and programming on CoverOregon.com while Deloitte is doing the consumer interface, Holm said.
Oregon can't blame the federal HealthCare.gov website for its woes. The Oregon Legislature mandated that the state exchange build its own system that would be a one-stop shop to apply for either Medicaid or Obamacare, Holm said. To that end, Oregon had to build its own “rules engine,” she said. “We have over 1,700 eligibility rules that have to work right to determine eligibility,” Holm said. For now, they don't.
Instead, enrollees can go to the site and shop and then submit an application online, Holm said, or they can go to a community partner or agent and fill out an application, submitting it by fax or mail.
“You can shop online. You can look and compare plans online. You just can't enroll online,” she said. “We are encouraging people to not wait until the technology is fixed. We are encouraging people to send in paper applications.”
Meanwhile, Kitzhaber announced on Nov. 1 the hiring or temporary reassignment of 100 state workers to help Oregonians enroll in private health plans under the Patient Protection and Affordable Care Act.
State workers and a cadre of community-based guides are also being asked to redouble their efforts to identify and encourage people eligible for the state's expanded Medicaid program and to use Oregon's federally approved “fast-track” enrollment process.
Kitzhaber has asked the Oregon Health Authority, the Oregon Insurance Division and the Department of Administrative Services to help move the enrollment paperwork from enrollees. “As Cover Oregon works to get online enrollment up and running, we are adding new signup options and more resources so that Oregonians get the insurance they want and need,” Kitzhaber said in a news release. “We are going to do whatever it takes to get this done for Oregonians.”
Roughly 15% of Oregon's population is uninsured, said Patty Wentz, spokeswoman for the Oregon Health Authority, the state agency overseeing the Medicaid program called the Oregon Health Plan. About 257,000 Oregon residents will enroll in the state's expanded Medicaid program over the next three years, she said.
In contrast to the dismal private plan enrollment on the exchange, Oregon has signed up 70,000 people for its expanded Medicaid program covering adults with incomes up to 138% of the federal poverty level.
Eventually, once the Cover Oregon website is operational, Wentz predicted the state will get 95% of its residents covered.
From the start, Oregon had planned to use a lot of people along with the technology to assist with citizen enrollment. Before the Oct. 1 launch date of CoverOregon.com, the state had 2,000 insurance agents and another 200 to 400 staffers from more than 100 community-based organizations to help citizens sign up.
So far, no political firestorm has arisen over the botched rollout of CoverOregon.com, despite it “not having much better luck than the feds,” said Chris Apgar, president and CEO of Apgar & Associates, a Portland-based health IT privacy and security consultancy. Oregonians are “more indifferent than they are anything else,” Apgar said. “There's not a big buzz about, 'I can't enroll.' It's just a general ribbing that we give government anyway.”
Still, Apgar said it's notable that Kitzhaber has personally intervened. He said the governor must be thinking that “this is making me look bad.”
Follow Joseph Conn on Twitter: @MHJConn