CoverME.gov

When Maine’s Governor notified CMS that her administration intended to transition Maine to a state-based marketplace using the federal platform (SBM-FP) in August 2019 it signaled Maine’s intent to switch to a fully state-run exchange at a later date. In fact, state legislation was pushed through and Maine contracted with IdeaCrew at the end of January 2021 to provide the marketplace platform (called CoverME.gov) to enroll Mainers in coverage ready for open enrollment starting in November that year. The challenge: IdeaCrew had only 8 months until October to launch. No one had ever transitioned a state from HealthCare.gov that quickly.

IdeaCrew already had a cloud-based marketplace technology platform, successfully supporting marketplaces in the District of Columbia since 2015 and Massachusetts since 2017. The challenge would be to tailor this platform to provide Mainers with the best customer experience, plan choices and lower premiums while seamlessly transitioning the 60,000 Mainers with coverage on HealthCare.gov to the new platform.

In the first 30 days, IdeaCrew engaged key stakeholders to synthesize plans, key milestones and dependencies for launching Maine’s new marketplace later that year. In addition to the sponsoring agency, the state’s newly formed Office of the Health Insurance Marketplace (OHIM), key stakeholders included;

• State of Maine departments; Office for Family Independence (OFI), Office of Information Technology (OIT), Maine Bureau of Insurance (BOI).
• Federal agencies; Center for Consumer Information and Insurance Oversight (CCIIO), Centers for Medicare and Medicaid Services (CMS) and Internal Revenue Service (IRS).
• Other critical partners: Insurers, Brokers, Navigators and Consumer Health Advocates including Tribes.

By August, IdeaCrew received the necessary approvals from CMS to launch the new Marketplace, including:

• A single streamlined application providing accurate, real-time eligibility assessments for Medicaid and CHIP, and determinations of advanced premium tax credit eligibility.
• Connectivity to the Federal Data Services Hub (FDSH) for secure electronic verification of citizenship, immigration status, income, and other coverage.

By October, IdeaCrew platform launched with:

• Accounts set up for all 60,000 Mainers enrolled on HealthCare.gov, ready to automatically reverify eligibility and be auto-renewed in plans certified by BOI and CoverME.gov for 2022 coverage.
• Four insurers ready to process enrollments. To ensure a smooth transition, IdeaCrew adopted HealthCare.gov’s Electronic Date Interchange (EDI), reconciliation and incident management processes to minimize changes insurers had to make in the short implementation timeframe.
• Advanced, consumer-driven tools powered by Consumers’ CHECKBOOK to help customers navigate the different options and select the best health plan for their families based on total out-of-pocket cost estimates, providers, and prescription drug coverage.
• Integration with the state Medicaid agency to send and receive applications. Again, to ensure a smooth transition, IdeaCrew started with HealthCare.gov’s account transfer protocol to minimize the impact on the state Medicaid agency.
• A Customer Relationship Management (CRM) for the new consumer assistance center integrated with interactive voice response (IVR) system and chat for live person support
• Brokers with existing clients on HealthCare.gov able to access their books of business, and registration for new Brokers and Assisters. By the beginning of open enrollment, 500 of these experts were certified and ready to support consumers applying for and enrolling in coverage.

By January 2022, a record 66,000 Mainers (10% increase) had enrolled in coverage
through CoverME.gov. While Maine’s vision for its own state-run marketplace had
been achieved in record time, no one is resting on their laurels. This is just the start
of a journey to connect more Mainers with affordable, high-quality health insurance.
Through CoverME.gov and IdeaCrew, Maine has the platform to build on its initial
success.