GAO Calls for Better Oversight of IT in State Healthcare Marketplaces

State healthcare marketplaces, created under the Patient Protection and Affordable Care Act (ACA), have made improvements over the past year, but problems still exist, according to a new report from the Government Accountability Office (GAO).

Healthcare.Gov, the Federal healthcare marketplace, has been plagued by problems since it went live in 2013, submitting the Federal government and its IT contractors to harsh public scrutiny. This new report shows that marketplaces, set up by the states themselves, are also falling short, failing to seamlessly help beneficiaries enroll in healthcare insurance plans.

The report found that many states faced project management challenges and time crunches as they struggled to develop the interfaces with insurers needed to screen applicants for eligibility. According to GAO, as of February, some functions of the state-based systems were still incomplete and required manual workarounds.

GAO determined that the Centers for Medicare & Medicaid Services (CMS), responsible for oversight of the project, failed to have a comprehensive communication plan. Guidance was scattered across websites and documents and some guidance was still in draft form at the time of GAO’s study. CMS also failed to keep senior state health IT officials in the loop on marketplace funding decisions.

According to GAO, many state healthcare marketplace systems failed to launch. GAO blames this on CMS, which in many cases conditionally gave states the go-ahead, even though states were still reporting hundreds of unresolved defects.

To improve the situation, GAO recommended that CMS:

  • define and communicate its oversight roles and responsibilities;
  • ensure senior executives are involved in funding decisions for state IT projects;
  • and ensure that states complete testing of their systems before they are put into operation.

Department of Health and Human Services officials agreed with GAO’s recommendations.

Diana Manos is a MeriTalk contributing writer.

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