Ensuring Program Integrity of State Health Insurance Exchanges and Expanding Healthcare Coverage Options for Consumers

The Context

The Affordable Care Act (ACA) allows uninsured Americans to obtain health coverage through one of three ways: the Federally Facilitated Exchange managed by the Department of Health and Human Services, a State-Based Exchange that uses the Federal Platform and healthcare.gov for enrollment, or through a State-Based Exchange that runs independently and performs all marketplace functions, including eligibility and enrollment. 

Unique to how states provide residents with access to high quality, affordable health insurance while retaining ACA’s basic protections, Section 1332 of the ACA also allows states to apply for a State Relief and Empowerment Waiver to pursue strategies relevant to their constituents. The 1332 waiver is similar to a Medicaid waiver, in that it allows states that wish to pursue such strategies to receive formal Federal approval to do so.

Cognosante supports a program that provides operational and oversight support for a Federal agency to effectively administer State Exchanges and Section 1332 waivers. With states participating as partners to the Federal administration of the Affordable Care Act, success is dependent on how effectively all partners work together to create a best-in-class customer experience.

The Challenge

As a contractor supporting the Federal agency, Cognosante was tasked to ensure effective program delivery through:

• Operations support to ensure that all State-Based Exchanges (SBEs) and State-Based Exchanges using the Federal Platform (SBE-FPs) remain stable and competitive,
• Innovation that fosters competition and expanded consumer options through increased and focused delivery of technical assistance and best practices to states, and
• Program integrity through oversight of State-Based Exchange and 1332 waiver program requirements.

Our Innovative Solution

The Cognosante team provides the program management, data analytics, and technical expertise to meet these critical objectives. More specifically—

• Using existing Federal investments in tools and licensing, we facilitate the reporting and collection of State-Based Exchange enrollment data and support the Federal government in conducting open enrollment readiness reviews for each State-Based Exchange.
• We provide gap analysis and state-attested regulation trends with real-time visualizations of the progress made in all participating State Exchanges.
• The team also oversees the audit-coordination and post-audit monitoring of 1332 waivers, and provides technical support for information management, data management, and reporting.

Our Tangible Results

The project team was recognized by FedHealth IT in 2021 as an Innovation Award winner for:

• Leveraging data analytics and visualization to improve the efficiency of validated State-Based Exchange enrollment metrics, which has also helped reduce data silos
• Bringing efficiency and program integrity to the administration process, and
• Effectively using human-centered design techniques to resolve problems.

Through these efforts, the team has reduced the margin of error in reporting, decreased time spent on quality control, and eliminated unnecessary data collection; thereby helped enable more healthcare options for state healthcare consumers.

Learn more about how we assist Federal and state healthcare agencies implement and manage their eligibility and enrollment programs through technology innovation.