A state audit of Covered California's use of sole-source contracts recommends reinstating independent verification and validation (IV&V) services for the computerized system that allows Californians to enroll in health insurance plans.
The audit released Tuesday says the California Department of Health Care Services and the Centers for Medicare and Medicaid Services, and Covered California spent $493 million "to rapidly build a system that interfaces with certain state, federal, and private entities — CalHEERS — and which has resulted in some risks to system maintainability."
Without IV&V, "these system issues may go unidentified or unresolved, resulting in long-term cost and schedule implications for the ongoing maintenance of CalHEERS," the auditor wrote.
The State Auditor's Office noted the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) is functional, but according to the chief of the project management office at CalHEERS, independent project oversight services ended in January 2016.
CalHEERS includes the public-facing Covered California Web portal that allows Californians to shop for health insurance under the Affordable Care Act, as well as the back-end rules engine that determines eligibility and enrollment processes for the California Health Benefit Exchange, Medi-Cal and Healthy Families programs.
From the project’s inception through June 2017, the state estimates it will spend a total of $864 million on CalHEERS for development and implementation, and maintenance and operation. CalHEERS initially launched in October 2013.
As Techwire reported last month, day-to-day management and oversight of CalHEERS has moved from Covered California to the Office of Systems Integration (OSI) so that stakeholders of the health benefit exchange can focus on their lines of business.
OSI and the state auditor both have said new major releases CalHEERS will be forthcoming in the future.
