Covered California Celebrates for a Moment, Goes Back to Work

Here’s a report from our Sawait Hezchias-Seyoum on yesterday’s Covered California board meeting.

Executive Director Peter Lee unveiled the big number in his opening remarks at today’s Covered California Board meeting showing that California has exceeded all expectations with the stat that close to 1.4 million people have enrolled for coverage through the Exchange and an additional 1.9 million have enrolled in Medi-Cal.  Everyone alike, from the Exchange staff, health plans, brokers/agents, enrollment counselors, hospitals to health professionals, clinics, advocacy organizations, community groups and others expressed congratulations, following the release of the latest enrollment numbers.

The enrollment update provided a glimpse of what current enrollment looks, not only by race and ethnicity, but also by service channel.  With regard to enrollment by race and ethnicity, it was noted that enrollment continued to get more diverse as time progressed. For example, the data showed that in the last few weeks, Latino’s comprised 39% of enrollment, which was a jump from 18% in the first three months.  Another piece of valuable information that was revealed during the update was that certain racial groups gravitated towards a particular enrollment channel.  For example, African Americans were more likely to self-enroll, while Asians and Latinos relied on agents.

Peter reminded everyone that while we should be very pleased by the progress we have made thus far, the work isn’t over, we are now in the “special enrollment” phase. During the special enrollment period, consumers will continue to be able to apply for the Medi-Cal program and Covered California will coordinate with partners to ensure people who are eligible to enroll in coverage due to qualifying special circumstances will be able to do so seamlessly. Speaking to the 800,000 Medi-Cal applications that are pending, Peter shared that Covered California is also coordinating with the Department of Health Care Services and California Welfare Directors Association on these pending Medi-Cal cases and Medi-Cal re-determinations, in order to develop seamless processes to assist consumers who are found eligible for Covered California to enroll without a tax penalty.  Dr. Ross followed this report by reassuring the group that the board and staff will not rest until the consumer experience is as user friendly as possible.

The update on Timely Access and Care touched on a variety of concerns including, concerns around accuracy of certain plan provider directories, timely access to available providers, and confusion about benefit design regarding what is in or out of network and physician confusion regarding their network status.  Included in this report was a recommendation of additional steps that could be taken to improve access to care.  There was a push by Dr. Ross and Kim Belshe to see that these additional steps were in fact pursued.

Advocates alike expressed the importance of consumers getting the care they need when they need it and urged the board and staff to pursue the recommendations outlined in the Timely Access and Care report, and additional efforts.

Of the handful of bills that were mentioned during the Legislative Update, SB 20 is of particular importance given that it’s an urgency bill. In light of the new open enrollment period established by the federal government, SB 20 would change California’s open enrollment period so that it conforms to federal law.  California’s current open enrollment period is from October 15 to December 7th, while the new federal open enrollment period is November 15 to February 15.

Following the Standard Benefit Design update, a handful of advocates thanked the board and staff for including in their proposal, pediatric dental as an embedded product and family dental also as an option.  Many advocates expressed disappointment at the proposal to increase the medical deductible in the Silver 73 plan and urged the board and staff to reconsider. Lee reminded the audience that the plan by definition had to have a certain amount of cost-sharing, and that many services were provided outside the deductible.

Finally, the board approved the 2014-15 budget and also a 16% increase in the current year’s budget.  The increase in the current year’s budget did not come without questions from the board about why the need for an increase.  Staff explained that a significant chunk of the cost, $112 to be exact, was a result of the many changes that needed to be made to the CalHEERs system, a lot of unanticipated changes that were necessary to comply with federal standards.

The board also discussed proposals for building next year’s budget, including an increase in call center staff. Also worthy of mention is the recommendation by staff to change the method of payment on outreach and enrollment activity from a per application construct to a grant based funded program.  The board will consider this recommendation at a future meeting. However, there was a lot of support from groups for this change at today’s meetings.

LA, the Lab for Health Reform and What’s Next?

Covering the remaining uninsured in Los Angeles is the topic of several essays, by us and colleagues and others, at Zocalo Public Square this week: http://www.zocalopublicsquare.org/2014/04/14/welcome-to-the-u-s-heres-your-health-insurance-card/ideas/up-for-discussion/

We focused on the effort by the county to extend coverage for the undocumented through the county health care system, which would build upon the remarkable work of Los Angeles as a laboratory for health reform to date.

These essays, and others, are reading for a forum tonight, Tuesday, April 15th. It is likely to be an interesting discussion, at the Goethe-Institut Los Angeles, 5750 Wilshire Blvd. Los Angeles, CA. More information here: http://www.zocalopublicsquare.org/event/?postId=52987

Medi-Cal Gets the Budget Breakdown…

On Monday, the Assembly Budget Subcommittee 1 on Health and Human Services, chaired by Assemblymember Shirley Weber, took up a variety of items around Medi-Cal and the Affordable Care Act, of which many were held open for further deliberation. Here’s a report by our legislative advocate Sawait Hezchias-Seyoum:

Among several items, the committee considered restoration of several Medi-Cal Optional Benefits, including adult dental services, which were eliminated as part of the 2009 Budget Act.  The Department clarified to the Committee that the restored dental benefits, that begin May 1, 2014, will be available to women in the pregnancy-only Medi-Cal program, as well as parents and childless adults newly enrolled during the expansion. This item was held open.

The Committee also deliberated on the Affordable Care Act (ACA) Pregnancy Services Proposal.  The discussion on this item was similar to the discussion that took place in Senate Budget Committee on Health and Human Services.  Health Access testified in support of a bright line at 138% FPL for full-scope Medi-Cal for pregnant women. Several groups expressed their opposition to the current wrap-around proposal due to the fact that CPSP services would not be preserved, arguing that that CPSP services provide valuable psycho social, nutritional and mental health benefits.  Other advocates urged the Committee to preserve full scope Medi-Cal, arguing that pregnant women should not be treated any different than any other person. This item was held open.

The discussion around the ACA Medi-Cal Eligibility Integration with CalHEERS garnered considerable attention, given recent reports indicating that 800,000 Medi-Cal applications have not been processed due to a system glitch.  Toby Douglas, on behalf of the Department acknowledged that the attempt to integrate the Medi-Cal Eligibility determination system with CalHEERS has not been without challenges.  Toby indicated that the Department is committed to continuing to work out the challenges they are experiencing. Advocates, including Health Access and Western Center on Law and Poverty urged the Department to explore different self-attestation alternatives as a solution to the back log of un-processed Medi-Cal applications.

The proposal to establish a Statewide Outpatient Medi-Cal Contract Drug List was another item that garnered considerable attention, as was the case when it was discussed in Senate Budget Subcommittee 3 on Health and Human Services.  The health plans expressed their opposition, citing failed attempts by other states, including Ohio and Texas. Most groups, including Health Access expressed appreciation to the Committee for holding this issue open, given the complexities that exist around the issue.

Senate Health Committee 4/9/2014

The Senate Health Committee, chaired by Senator Dr. Ed Hernandez, took up four bills of interest to health advocates that Health Access is supporting: SB 1340 (Hernandez) on Health Provider Contracts, SB 1276 (Hernandez) on Health Care Fair Billing Policies, SB 1124 (Hernandez) on Medi-Cal Estate Recovery. Here’s a report from our legislative advocate Sawait Hezchias-Seyoum on the hearing on these bills and others:

SB 947 (Anderson) would prohibit the California Health Benefits Exchange, Covered California, or any of its contractors from disclosing personal information without express permission of the individual providing that information. Given fears that the bill as written would hinder enrollment efforts, Health Access joined others in an oppose unless amended position expressing support of the intent to protect the privacy of consumers who apply for coverage, but opposition to the bill in its current form. Advocates argued the bill does not balance the need to protect consumer identity with the need to ensure Californians who want help accessing health care can get help they need. Senator Anderson expressed commitment to address opposition concerns. This bill passed out of committee with a vote of 8-0.

SB 1340 (Hernandez) would eliminate gag clauses in contracts between all types of health providers and health plans or insurers, thereby ensuring consumers have better access to health care cost and quality information. Transparency of cost and quality is essential to helping to control health care costs while improving health care quality.  This bill passed out of committee with a vote of 8-0.

SB 1124 (Hernandez) which would limit Medi-Cal estate claims recovery to inpatient nursing home care for those over age 55 passed out of committee with a vote of 7-1, with Republican Senator Jim Nielson voting no.  SB 1124 (Hernandez) is an important measure that will ensure California’s estate recovery program does not go beyond what is required in Federal law, and discourage people from enrolling in Medi-Cal due to concerns about estate recovery. The bill would align California with most states with regard to limiting estate recovery from a surviving spouse. Sponsors of the bill, Western Center on Law and Poverty and Health Access expressed to the committee that without the passage of this bill, many will continue to see Medi-Cal, not as safety net system, but as a loan.  WCLP was joined in support by the California Pan Ethnic Health Network, California Teachers Association, AFSCME and SEIU.

SB 1276 (Hernandez) would update existing law, sponsored by Health Access to assure uninsured and underinsured Californians are not overcharged for hospital care, by establishing the definition of a “reasonable payment plan” should a hospital or emergency room physician bill a patient who qualifies for charity or discount care and would ensure that the patient is not charged more than 5 percent of their monthly income. The bill passed out of Committee with a vote of 5-2, with Senator Wolk abstaining and Senator DeLeon, who was out of the room when the vote took place also not voting.  Republican Members, Senator Anderson and Senator Nielsen both voted no.  The California Hospital Association opposed the bill in committee asserting that the bill expands the number of people who would qualify for charity care, but committed to working with the author to resolve concerns and expressed the likelihood of removing opposition.  In response, Beth Capell, on behalf of Health Access, stated that SB 1276 (Hernandez) was mischaracterized as charity care, since there is no obligation to provide free care, only an obligation to provide care at the price of Medicare or Medicaid as is current law.  The Emergency Physicians Association also expressed opposition, asking Senator Hernandez to exempt emergency room physicians on the grounds that they are not hospital employees and should be treated differently.  In response to concerns raised by opposition, republican Senator Joel Anderson asked Senator Hernandez why the state doesn’t just fill the gap in payment. Recognizing that it is not all too often that Republican legislators suggest state funding for safety-net related programs or changes, Senator Hernandez pointing out that requiring the state to pick up the cost would result in general fund impact, but that he would explore state funding if he could count on Senator Anderson’s support with the bill (presumably with revenues.)

The biggest presentation of the meeting was a debate over labeling sugar-sweetened beverage, over a bill authored by Senator Bill Monning, which passed.

Assembly Health Committee 4/8/14

Here’s our write-up by our Sawait Seyoum on today’s Assembly Health hearing.

The Assembly Health Committee, chaired by Assemblymember Richard Pan, took up several bills of interest to health advocates, including a Health Access-sponsored AB 2088 (Hernandez) on Junk Insurance for Large Employers, as well as other matters like AB 1877 (Cooley) on Vision Care, AB 1952 (Pan) on Nonprofit Hospital Charity Care, AB 1962 (Skinner) on Medical Loss Ratio for Dental Plans and AB 2325 (Perez) on Medi-Cal Interpretation Services.

AB 2088 (Hernandez), which would make limited benefit plans supplemental to employer-based coverage passed out of committee with a vote of 13-6.  Joining Health Access in support, the California Labor Federation testified urging the committee to pass this bill to prevent workers from facing medical debt and bankruptcy after signing up for a limited benefit plan, unwittingly thinking that their plan meets minimum essential coverage.

AB 1877 (Cooley), which creates in state government the California Vision Care Access Council, modeled after the California Health Benefit Exchange to create a marketplace for the purchase of vision plans by individuals and employers passed with 11 votes. Beth Capell, on behalf of Health Access, expressed appreciation to Assemblymember Cooley for accepting Health Access amendments that uphold important consumer protections similar to what Covered California has instituted.

AB 1952 (Pan) which would impose a penalty on nonprofit hospitals which fail to spend 5% of net patient revenue on charity care passed out with a vote of 11-7. Health Access expressed a support if amended position, seeking to work with the author and sponsor to further define charity care and to include hospitals operated by integrated health systems.

AB 1962 (Skinner) which would establish a minimum medical loss ratio (MLR) of up to 85% for health plans and insurers offering large group dental coverage or less than 80% for health plans and insurers offering individual and small group dental coverage passed out of committee.  Health Access expressed a support if amended position supporting the concept of a medical loss ratio for dental plans, while wanting to be part of a conversation that sets what that minimum should be.

Another bill that also passed out of Committee includes AB 2325 (Perez), which would establish the Medi-Cal Patient-Centered Communication program (CommunicCal), to provide and reimburse for medical interpretation services to Medi-Cal beneficiaries who are limited English proficient (LEP). This bill is an important measure that will help ensure that many newly insured Californians can truly benefit from their new access to health care by being better able to communicate with their doctors.

A Week After Open Enrollment Ends, What’s Next? Phase 2!

One week ago was the end of open enrollment of the Affordable Care Act, and the subsequent announcement that over 1.2 million Californians had signed up for private health plans through Covered California (and over 7.1 million in marketplaces through the United States). Health and consumer advocates point out that the work continues on the Affordable Care Act in California, with “phase two” of health reform to ensure access to high quality coverage and healthcare for all Californians.

A recent report, “Mission Advanced but Not Accomplished: Four Years of Health Reform in California,” outlined the much needed work left be done to implement and improve the Affordable Care Act in our state:

1) Helping Californians who started applications prior to 3/31 to finish picking a plan by 4/15; and ongoing enrollment in Medi-Cal and Californians amidst life changes;

2) Improving the customer service experience, and tool to help select plans;

3) Extending coverage and help to the remaining uninsured;

4) Enforcing strong consumer protections to ensure timely access to care once in coverage;

5) Working for accountability and transparency for increased quality and reduced cost. 

ENROLLMENT: The work to sign Californians up for coverage has not ended: Thousands of Californians who started the process of signing up before the deadline have a grace period until April 15th to finish and pick a plan. Hundreds of thousands of other Californians have ongoing opportunities to enroll based on their income or change of life circumstance. California should be pro-active is getting people during job changes, moves, divorce, graduation, and other life moments when people often lose coverage.

California also needs to improve the customer service experience to make it easier to sign up, from reducing wait times at the call center and increasing the number of in-person enrollment counselors, to improving the website and plan selection tools on quality rating and searching for providers. These improvements are needed not just for the next open enrollment period, but even before, as new graduates and others have the opportunity to sign up for coverage in the next few months.

CONSUMER PROTECTIONS IN COVERAGE: Once Californians are insured, they need to have the security and consumer protections that the coverage is meaningful. It’s up to California regulators to be vigilant in their enforcement of consumer protections. Regulators need to ensure that networks have an adequate number of medical providers, and that patients can get the care they need when they need it. Health Access is the sponsor of several related bills including SB964(Hernandez), that would increase oversight over network adequacy of health plans. California legislators have the opportunities to close loopholes and increase oversight over insurers to ensure that consumers get the care they need, and the promise of the health reform law is fulfilled.

THE REMAINING UNINSURED: While the Affordable Care Act has already begun to dramatically reduce the number of uninsured, it’s up to state and county policymakers to finish the job, and take additional steps toward a more inclusive and more efficient health system. Counties need to maintain and extend their safety-net programs to the remaining uninsured. We are pleased to pursue a statewide solution, SB1005(Lara), legislation to extend the help the Affordable Care Act provides, but to all Californians, regardless of immigration status.

COST AND QUALITY: The Affordable Care Act provided new tools to help prevent illness and control cost. Partially as a result of the Act, health care costs has risen slower in the last four year than anytime in the last fifty, but there’s much more to do to make this trend sustainable. California policymakers and voters have options this year to make the health industry more transparent and accountable for the goal of reducing costs and improving quality.” Health Access supports specific legislative proposals on this subject, as well as pending November ballot measures to regulate health insurance rates and cap hospital charges.

Health Advocates Highlight Ongoing Opportunities for Enrollment

As open enrollment officially came to an end yesterday, health and consumer advocates are highlighting today the coverage options are still available for Californians through the rest of the year. Those who tried to enroll by March 31st but had issues now have a grace period to finish their sign-up by April 15th. But beyond that, other enrollment opportunities exist, depending on life circumstances, now and into 2014.

But the end of open enrollment is not the end of opportunities to get the coverage Californians need when they need it. For people who lose their income, Medi-Cal continues to be available throughout the year. For all those reasons that people lose coverage, from graduation to divorce, Covered California will continue to be the place to sign up and prevent facing the health and financial consequences of being uninsured. Hundreds of thousands of Californians are still eligible to sign up for coverage, depending on their circumstances:

·         For example, Medi-Cal which expanded coverage to low income adults without child dependents up to 138% of poverty level in January, has ongoing enrollment.  Whether a low-income working family, an undocumented immigrant youth who is covered under Deferred Action for Childhood Arrival (DACA), or someone who is in between jobs, Medi-Cal is available.

·         Californians who are going through life changes can get enrolled during the “special enrollment period.” Projections are that over a million Californians will be eligible, including:

o   Changes in family status, including divorce, marriage, having a new baby, or adopting, or otherwise adding a child to the family;

o   Moving to California, or from one region to another;

o   Graduation, including the thousands of Californians who will graduate from high school or college in May and June of 2014;

o   Changing jobs, being between jobs, being released from jail, or otherwise losing one’s coverage.

Joining Health Access were community and constituency organizations:

“For families that are welcoming children via birth or adoption, it’s important to remember that the opportunity for coverage is still available. As we work to get all Californians covered, it’s critical for parents to ensure their children get enrolled in health coverage,” said Kelly Hardy, Senior Health Policy Director, Children Now

“Even though yesterday was the last day of open enrollment, all low-income lawfully present Californians can still enroll in Medi-Cal, if they meet certain requirements. This includes recent immigrants who are subject to the five year bar and those who have been granted deferred action through the Deferred Action for Childhood Arrivals Program,” said Ron Coleman of the California Immigrant Policy Center.

“Open enrollment is over, but it’s not the end for young adults. Young people are very likely to qualify for special enrollment periods triggered by life events like moving, changing jobs, and getting married,” said Tamika Butler, California Director at Young Invincibles. “Many young adults are also eligible for Medi-Cal, which offers ongoing enrollment. If you’re between jobs, or covered under DACA, it’s not too late to get covered.”

Don’t Say Goodnight, Say Grace Period…

As hundreds of thousands of Californians try to get enrolled in the new health insurance options and benefits today, Covered California announced that those who tried to sign-up today have option for a grace period from now through April 15th to complete their application.  So far, over 1.2 million Californians have now selected a plan through Covered California, the new state health care marketplace under the Affordable Care Act.

No Californian who tried to enroll should be frozen out of coverage, so this additional consideration is appreciated and necessary. All Californians have an interest to get as many people covered as possible, so our state is healthier and more financially secure, and we draw down federal dollars into our health system and economy. When there’s a long line at the voting booth at closing time, a judge usually keeps the polling place open until everyone online gets a chance to vote. By the same token, folks who tried today but faced system issues should be given another opportunity.

Even without the grace period, Californians are not just beating the goals set for the end of March and the first open enrollment period, but to surpass the goals set for the second open enrollment period at the end of the year. Even with these big numbers enrolling, we fear more Californians who were discouraged by long line, a slow or stalled website system, or a inordinate call center wait time–and they deserve a two week grace period to try again to finish the process. Most of these over one million Californians in Covered California are newly covered or have coverage that is cheaper or better than what they had before.  Since California had one of the worst rates of uninsurance in the nation, there’s no shock that there’s a great demand for these new coverage options and benefits.

Deadline Day & California’s 4 Year Progress

HEALTH ACCESS ALERT:

Monday, March 31, 2014

SURGE OF SIGN-UPS LEADING UP TO TODAY’S DEADLINE DAY TO ENROLL IN NEW COVERED CALIFORNIA HEALTH PLAN OPTIONS AND BENEFITS

*        Crucial outreach & enrollment activities happening today. Please urge friends & family to visit www.coveredca.com in California, or www.healthcare.gov nationally today!

*        Health Access Report on 4 Years of ACA in California shows over 3.5 million Californians already enrolled in mid-March, including: 1.1 million in Covered California; 2 million determined eligible in Medi-Cal, and 430,000 young adults on their parent’s plan.

       Report lists top 8 ways that California has gone above and beyond the Affordable Care Act; the two dozen pieces of state legislation that implemented and improved the law; the pending bills this year; and the 4 big things left to do.

*         Deadline today is real: Californians must start their application process for today, but will have grace period to finish selecting plan (if needed) through April 15th.

 

Be a Member of Health Access To Help CA Seize The Opportunities In Health Reform

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Thousands of Californians are clicking and calling to get signed up for new Covered California options and benefits today, the last day of open enrollment. Today is the deadline to at least start an application at www.coveredca.com, although there is a grace period to finish selecting a plan by April 15th. Community enrollment counselors, county workers, brokers and agents, Covered California call center workers, and many others will be very busy today responding to the demand, which spiked in the last week and through the weekend.

It’s a critical day to reach out to friends, family, and others to make sure they are covered. Call or E-mail them to start their applications today, and join millions of others who recently signed up to get access to care, peace of mind, and the other benefits that come with coverage. By signing up today, they can avoid the health and economic consequences of being uninsured: living sicker, dying younger, and being one emergency away from financial ruin. Instead of a tax penalty, signing up could qualify them for tax credits that could be worth hundreds or even thousands of dollars, pegged so that no one pays more for a premium than a percentage of income. If folks don’t sign up today, those dollars stay in Washington, DC, rather than helping California’s struggling health system and economy.

By mid-March, Covered California reported that over 1.1 million Californians had selected a plan through their portal, with over 85% also qualifying for subsidies to afford coverage, so their premiums are not more than a percentage of their income. The enrollment is higher now, with tens of thousands joining in just the last few days. Last week, the Obama Administration announced that the national figure for sign-ups in the marketplaces (like Covered California) set up by the Affordable Care Act (ACA) totalled over 6 million. These figure don’t include other ACA expansions, including Medicaid.

NEW 4-YEAR REPORT SHOWS PROGRESS TO DATE: Due to California’s efforts to both implement and improve upon federal health reform in the four years since the enactment of the Affordable Care Act (ACA), California now leads the nation, providing new coverage options for over 3.5 million Californians: not just the over 1.1 million in Covered California products, but another 2 million in Medi-Cal, and 430,000 young adults on their parent’s plans. Millions more are getting new consumer protections and financial relief under the ACA as well. A new Health Access report details the impact of the Affordable Care Act in the last four years, both the positive expansions of coverage, but also those components where the Act was insufficient or more work at the state level is needed.

What is notable about the progress in California is the urgency of the health care crisis prior to the ACA. California had the seventh highest uninsured rate in the nation: Californians were more likely to be uninsured than residents of all but six states. Californians were more like not to get coverage at work, more likely to be not able to afford coverage, and more likely to be denied coverage due to pre-existing conditions than in many other states. The severity of the health care crisis is a key reason California has “embraced” reform, as Governor Jerry Brown stated this month, and makes this record all the more compelling. Even though California is the only one of the states with the top ten highest uninsured rates with a Democratic Governor, it is an example for other states that are similarly situated in terms of health care need if not of like minds politically.

Even with the significant progress, much more work is needed to fully realize the promised of health reform, from providing world-class customer service; to offering additional help to fellow Californians that need it; to requiring strong oversight to ensure timely access and strong consumer protections when dealing with an insurer; to putting in place additional policies to reduce costs and increase quality, and encourage a healthier California.

The report tallies the impacts of the Affordable Care Act in California to date; details how California has taken a leadership role in implementing and improving the law; and also lays out the important next steps needed to be taken by state policymakers so Californians can take full advantage of their new rights, options, and benefits. This report serves as a “to do” list of state actions taken and those still awaiting action, with appendices that list ACA-related legislation that has passed and is pending.