Supporting Maine’s journey to a state-based marketplace

In 2020, Maine took a bold step to improve health insurance access for its residents, transitioning from the federal marketplace to a state-based marketplace (SBM). Recognizing the importance of this initiative, the state sought a partner to ensure a seamless, customer-focused transition. With a proven track record in eligibility and enrollment services and expertise supporting SBM transitions and implementations, Maine selected Maximus to operate the Consumer Assistance Center for its newly launched SBM, CoverME.

Challenge

Facing the dual challenges of the COVID-19 pandemic and a shifting federal healthcare landscape, Maine desired a swift, effective transition to an SBM — bringing a sense of urgency and a tightened timeline to the project. The pandemic added another dimension of complexity, necessitating a fully remote set-up and posing challenges in staffing and coordination. The state also had to quickly coordinate with the technology vendor to implement the eligibility and enrollment application and the consumer relationship management system.

Solution

Despite all of these challenges, Maximus was up to the task.

To streamline Maine’s transition to an SBM and support the enrollment process, we leveraged our extensive experience operating successful consumer contact centers nationwide to efficiently and effectively meet the specific needs of Maine’s Office of Health Insurance Marketplace (OHIM). Our team adapted the training and process documentation we developed for other states, tailoring it to meet Maine’s unique needs. This intentional leveraging of existing strategies and processes expedited the training and set-up phases, ensuring the project remained on track.

Working in close partnership with the state’s technology vendor and OHIM, we employed a structured, strategic planning and implementation methodology with a focus on integrated processes to successfully meet the first open enrollment deadlines and provide needed support to Maine’s consumers during the transition.

Results

Within two months of contract signing, we worked with the Maine OHIM to stand up the fully operational Consumer Assistance Center, provide mail processing and handling, and prepare nearly 500 brokers for certification before the go-live date of November 1, 2021.

• Initial achievements: Despite the compressed preparation timeline, the impact of the pandemic on staffing, and the largely remote implementation, CoverME, with the support of the Maximus Consumer Assistance Center and the technology vendor,  enrolled 66,000 residents in health coverage during the first open enrollment period. This demonstrated the effectiveness of providing access to quality, affordable health coverage during a time of unprecedented public health challenges.
• Ongoing improvements: Following the initial enrollment period, a collaborative, lessons-learned process with OHIM led to significant enhancements in training content and customer service processes, improving overall efficiency and user experience for future enrollments. In partnership with OHIM, we made iterative improvements that optimized operations and addressed feedback from consumers, brokers, assistors, and other stakeholder groups.
• 2025 open enrollment period: The improvements resulted in year-over-year growth in new consumers and adults covered through plan selections, as well as robust consumer engagement and plan comparison activity.

The Maximus difference

Our approach to the Maine SBM implementation demonstrates our deep expertise and innovative problem-solving capabilities. By adapting strategies and tools tested in other states, we met ambitious project timelines and ensured the scalability and sustainability of the state’s health insurance marketplace.

As importantly, the project's continuous improvement ethos has set Maine’s SBM on a path of ongoing enhancement and success. The systems and processes implemented address immediate needs while supporting future growth and challenges, ensuring lasting benefits for Maine’s residents.