Minnesota residents and county officials are continuing to voice frustrations over the MNsure application process.

And no one knows that more than staff at Sherburne County Health & Human Services (HHS), where those applications are being processed.

“Today, I can report that implementation has been very slow - more slowly than expected. Truely, the real work is just beginning,” Mary Jo Cobb, Director of Sherburne County HHS told the county commissioners last week.

In June, 2013, the county board approved the hiring of seven additional limited-term staff to help implement MNsure in Sherburne County.

“The plan was that eventually the system would be so automated that we wouldn’t need these positions in order to continue providing the same service,” said Cobb.

But things haven’t gone according to plan. Although 6,200 people in the county have now enrolled in a managed healthcare program through MNsure, the application process is still nowhere as “automated” as was expected.

HHS staff had to be trained on the new MNsure software program, which is completely new to them.

Denise Ringwelski,  lead MNsure worker with the county, said staff had to learn over 150 new processes in order to do their daily work. The system is constantly being revised, with sometimes daily announcements changing different steps in the process.

And if it’s that confusing to staff, it’s even more confusing to the public trying to enroll.

“One of the biggest impacts is the increase in the number of phone calls and walk-in clients. They’ve more than doubled,” said Ringwelski “We’ve actually had to pull two staff off every day just to handle the phone calls and the walk-in clients. Since the end November, we’ve had about 1,650 calls just regarding MNsure applications.”

It’s not that the system hasn’t seen any improvements, said Ringwelski. Last year, the MNsure system had its own software issues where people couldn’t even gain access.

Now the problems are more related to answering questions and verifying eligibility.

 

“This year there’s more questions, like, “How do I apply? What kind of healthcare do I have? How do I answer this question in the system? What do I need to report?” said Ringwelski.

 

“The website is good, but people have to read the instructions in detail in order to get through the system.”

 

After the state shifted healthcare training back to counties, 36 county HHS staff spent over 350 hours in training on the Affordable Care Act policies and procedures just to be able to get it implemented. Then last November, paper applications for MNsure were also re-routed back to counties.

 

“We received our process. It was 57 pages long just to enter an application,” said Ringwelski. “It used to take about 45 minutes to enter an application. Now it can take two to three hours to get it into the system.”

 

If a client fails to answer one question on their 30-page paper application, it won’t get processed and HHS has to contact the client. And although the online application process is simpler, it isn’t foolproof.

 

“People have been able to get in and apply online, but the counties are still not able to process simple changes,” said Ringwelski. “If someone wants to add a household member to their case, we have to go through almost 150 questions to get them into that system. We have about 200 pending cases every month that don’t go through.”

 

Even though some applicants don’t need subsidized healthcare, all pending MNsure applications are routed through the county.

 

“Any pending case that doesn’t go through, we get those calls. It could be somebody who will actually be purchasing a plan, but that call comes here,” said Ringwelski.

 

Since last March, HHS has doubled its number of caseloads for healthcare staff. It’s now at 720 per worker. And staff will be converting more that 1,000 cases from the old data system to the MNsure system in the next few months. Then in July starts another conversion of 7,400 more cases.

 

“Mary Jo was right when she said our work is just starting,” said Ringwelski.

 

Cobb said when the county hired the new limited-term staff in 2013, it was with the understanding the county would get reimbursed 75% of those extra costs. That didn’t happen either.

 

“When we realized reimbursement for these positions was going to be 50% instead of 75%, we held off on hiring two positions,” said Cobb. “But with all of the conversions, we are probably going to have to hire one of those and train them.”