October 1 is the day public health insurance exchanges finally kick off. Are the exchanges ready to go?

For the most part, people will be able to shop for policies, apply for a health plan and request a subsidy online, but not in all cases and often not without some degree of in-person assistance.

Here’s a rundown on known problems with some of the exchanges:

* Late last week the Obama administration acknowledged that the portion of the federally-run exchanges geared to small business won’t begin accepting applications until November 1, a month later than planned.

An administration official said that small businesses that want to purchase coverage for their employees would still be able to enroll beginning tomorrow through paper applications, in-person meetings or over the phone. No official reason was given for the delay, but The Wall Street Journal reported that it was due to an unspecified “technological problem.”

* The District of Columbia's online health marketplace will be unable to perform two key functions when it opens, according to exchange officials. The DC Health Link, as the district’s health insurance exchange is known, will lack the ability to calculate whether someone is eligible for Medicaid or the size of the federal premium subsidy, if any, for which a consumer is qualified.

“DC Health Link is not currently deploying the function that makes new Medicaid eligibility determinations and calculates tax credits,” Mila Kofman, executive director of the DC Health Benefit Exchange Authority, said in a statement. This is due, she said, “to a high error rate discovered through extensive systems testing.”

People who might qualify for Medicaid coverage or tax credits will still be able to submit an online insurance application—if they are willing to do so without knowing what they'll be paying. Experts will determine their eligibility off-line and applicants will be notified in early November, Kofman said.
There was no word on when the Medicaid and subsidy functions would be corrected.

* A similar problem is taking place in Colorado, where the state-run exchange, known as Connect for Health Colorado, will not be able to calculate federal subsidies for at least its first few weeks of operation. Instead, state residents who wish to determine if they are eligible for a subsidy will be directed to call a customer service representative, who will perform the calculation manually.

Connect for Health Colorado was not "completely satisfied" with the accuracy of the tax credit calculations, according to Ben Davis, an exchange spokesman. "There are 100,000 scenarios they want to test for" — combinations of income, family situation and other factors — “and it takes X amount of time,” he said. “We just did not have enough time to test."  Davis said Colorado will spend two more weeks testing the system "to make sure every possible scenario has been accounted for” and that the responses are accurate.

* Oregon's exchange officials reported last week that IT problems were causing policy information, such as deductible amounts, to appear incorrectly on a test site. "We are in a validation process with our carriers," said executive director Rocky King.

State-based exchanges run by the federal government reported similar display problems last month.

This story originally appeared on HIX, a SourceMedia publication focused on tracking the development of health insurance exchanges.

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