Cms Management For The Federal Marketplace: A Heathcare Case Study

Abstract:

This case study examines implementation of HealthCare.gov and the Federal Marketplace by the Centres for Medicare & Medicaid Services (CMS), from passage of the Affordable Care Act (ACA) in 2010 through the second open enrolment period in 2015. As required by the ACA, HealthCare.gov is the Federal website that facilitates purchase of private health insurance for consumers who reside in States that did not establish health insurance marketplaces. At its launch on October 1, 2013, and for some time after, HealthCare.gov users were met with website outages and technical malfunctions.

After corrective action by CMS and contractors following the launch, CMS ended the first open enrolment period with 5.4 million individuals having selected a plan through the Federal Marketplace.

In our oversight role for the Department of Health and Human Services (HHS), the Office of Inspector General (OIG) has a significant body of ongoing and planned audits and evaluations regarding the Federal Marketplace and other ACA provisions of high interest and concern to HHS, Congress, and other stakeholders.

These include reviews and suggestions for improvements related to the accuracy of Federal financial assistance payments; verifications of eligibility determinations for insurance, premium tax credits, and cost-sharing reductions; and CMS’s management of marketplace contracts and the security of personal information.

The objective of this case study was to gain insight into CMS implementation and management of the Federal Marketplace, focusing primarily on HealthCare.gov. Our review spans 5 years, providing a chronology of events and identifying factors that contributed to the website’s breakdown at launch, its recovery following corrective action, and implementation of the Federal Marketplace through the second open enrolment period. OIG calls on CMS to address identified problems and employ lessons learned from management of this project to avoid future problems with program implementation and to further strengthen CMS.

In conducting this review, we interviewed 86 current and former HHS and CMS officials, staff, and contractors involved with the development and management of the website. We also reviewed thousands of HHS and CMS documents, including management reports, internal correspondence, and website development contracts.

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