Author: Tracie Berardi

Last week, an article from IEEE SPECTRUM outlined the latest set of issues related to the Obamacare Affordable Care Act (ACA): hundreds of thousands of California Medi-Cal health insurance applications can’t seem to get past the approval finish line and significantly delay the start of healthcare coverage for over 900,000 Californians.

Several issues are to blame for this, and continue a string of problems for this site since its go-live date back in October 2013:

• The health insurance exchange website and infrastructure did not expect over 3.2 million residents to enroll for Medi-Cal health insurance coverage – more than 2.5 times the original estimate.
• The state-run Covered California exchange computer system was supposed to integrate with the 58 individual county social services computer systems by October 1, 2013, so that an applicant’s eligibility could be corroborated and the county managed care plan the applicant selected could be confirmed. However, this functionality wasn’t fully operational until January 21, 2014. Since the state is expected to take no longer than 45 days to process an application, the delay created an instant backlog of approved applications.
• A programming flaw in the Covered California website caused applications to be incorrectly denied and placed on hold.

It’s hard to believe that somebody did not see the amount of applications coming, given the healthcare laws in effect and the sheer number of low-income families in the state. Properly estimating the amount of concurrent users is a critical component of performance and load testing. But it doesn’t stop there: integration testing, penetration testing, regression testing, etc. Was enough time spent on testing this site to ensure high software quality, or was the site thrust into production amid political pressure despite known issues? We’ll never really know.

It’s important to find, prioritize, and fix the high severity bugs before production – before they maximize the instability of your production application AND to give you a chance to fix the bugs without worrying about upgrading a system with hundreds of thousands of active users. Don’t expect outsourced development to be perfect either. Make sure you hold their feet to the fire when it comes to enforcing quality software code and long-term maintainability, reliability, security, and performance efficiency. Build these SLAs into their contracts.

There is no timeline for the Medi-Cal backlog to be shrunk to just applications requiring more eligibility information. Last month, the state indicated that this could be accomplished by the end of June, but this date doesn’t look realistic when you consider that the revised eligibility renewal forms for 8 million Medi-Cal beneficiaries need to be returned by the end of June. Californians, you’re in for a long wait here.

The article referenced can be found here.