The head of Connecticut's health exchange said Friday there is a lot to work out following a federal decision to allow people with cancelled insurance policies to sign up for catastrophic plans under a hardship exemption.

For example, Access Health Chief Executive Kevin Counihan is unsure whether it will be available to state residents. His concerns over the federal decision, which also exempts those with cancelled plans from coverage mandates for a year, begin with whether it "supercedes state law."

Last month, Gov. Dannel Malloy passed on an earlier federal proposal to allow insurance companies to reopen health plans that were cancelled because they did not comply with Affordable Care Act standards.

That state decision complicates the question of how or whether the state can implement the federal decision to let people with cancelled policies jump into a catastrophic plan, Counihan said in a conference call with reporters Friday morning.

"The mind reels a little bit that something like this could be introduced four days before the close of open enrollment," he said. "It's just another card in the hand we're dealt and we're going to deal with it."

The solution, though complicated and plagued with questions about impacts on rates and risk, is a homegrown one. Counihan said that Access Health pitched the idea to the federal Centers for Medicare & Medicaid Services. But that doesn't mean it would have been a simple fix.

"Nobody knew this would become national policy," Counihan said. "This obviously represents a bit of a challenge in all the states."

To start, Connecticut's health exchange's is not set up to let people apply for a catastrophic plan if they either qualify for Medicare or are over 30 years old, due to federal rules. Because insurer's based their health plans on these age restrictions, stretching the original rules could upset risk pools and rates, Counihan said.

He said he has already contacted the state's Insurance Department and Connecticut's federal lawmakers. He plans to speak with the federal insurance regulators as well.

The health exchange has also launched an effort to inform 25,933 people who have started but not completed the the signup process. It is sending letters and calling people who haven't completed the application.

"We are very concerned that there could be the potential for people who didn't complete an application who think they have," Counihan said.

Enrollment in the exchange is moving along at about 1,400 a day, he said, and the total enrolled is about 47,000. By age, 30 percent are under 35 years old; 11 percent are 35-44 years old; and 52 percent are 45-64 years old. As of Friday, the split of sign-ups between Medicare and private health plans is 50-50, Counihan said.

Call wait time for the exchange has dropped to 20 minutes, Counihan said, after its call center beefed up its staff to 114 workers from 63 early this week.

The time is "not acceptable to us, but it's clearly better than what its been." Counihan said.

He expects that the Jan. 1 deadline, when coverage is supposed to begin, will be complicated. "This is complex," he said. "It's going to be bumpy there are going to be people who are unhappy."

(c)2013 The Hartford Courant (Hartford, Conn.)