Covered California Board Meeting Highlights

Covered California had its first board meeting of the year on January 15. Diana Dooley, Secretary of the state’s Health and Human Services Agency, was re-elected board chair. Dooley has held this role since Covered California was formed four years ago.

2015 Enrollment Update
Executive Director Peter Lee gave an update on Covered California’s 2015 open enrollment efforts. As of January 12, over 228,000 new enrollees have selected a health plan. Of those enrolled, nearly 9 out of 10 people are eligible for a subsidy, which highlights how the Affordable Care Act has made healthcare more affordable and accessible. Also, 28 percent of enrollees are Latino, 19 percent are Asian, and 3 percent are African-American.

Covered California has determined that another 300,000 people who are eligible for a subsidy but have not picked a plan and completed the enrollment process. Half of that group is Latino, 11 percent are Asian, and 6 percent are African-American. Lee said these numbers demonstrate the success of Covered California’s marketing and outreach efforts in these communities. They also highlight the fact that consumers need help understanding their options so they can pick the best plan for themselves. Covered California service representatives have begun calling people who’ve started the process to help them get enrolled into a plan. We hope a total of 1.7 million Californians (up from 1.2 million) will ultimately enroll before February 15.

Covered California has made progress but there is still more to do to assure that those who are eligible get coverage, particularly in the Latino, African-American and Asian Pacific Islander Communities. We offered comments at the meeting that focused on the need for the following:

  • Notification and transition of people between Covered California and Medi-Cal: Health Access echoed Western Center on Law and Poverty’s call for the need for a better process to notify individuals who are being transitioned into Medi-Cal because they no longer qualify for a subsidy. This is particularly important because there will always be people going back and forth between the two programs, and a smoother transition will ensure folks get continuity of care and don’t fall through the cracks.
  • Health Plan Call Center Metrics: Health Access also pressed the need for more information about call center metrics, particularly information about health plan call centers. There have been reports of people having significant problems reaching health plans and having this data will help us to address any challenges there.
  • LGBTQ Demographic Data:  Advocates repeated our requests for demographic data regarding sexual orientation and gender identity that should be on the Covered California application and in CalHEERS. Having this data will help us to assess and evaluate application and program enrollment data to see if LGBTQ individuals are adequately represented and tailor outreach strategies for this community. In addition, this data will help us to identify health disparities, just as we already do by region and other demographic categories such as gender identity and language spoken.

Covered California Adopts Policies Allowing New Entrants in Regions with Limited Consumer Choice

Covered California adopted policies on recertifying existing plans and laying out rules for how plans new to Covered California could participate in the exchange. Plans that have been in operation before Covered California was launched, but haven’t participated in the Exchange, can participate in the state’s 5 regions out of 19 regions where there are fewer than three health plan choices. These regions cover predominantly rural counties in Northern California and on the Central Coast. Health Access and other consumer advocates support Covered California’s efforts to give consumers more choice for plans, particularly in counties with only one or two plans available.

Health Access Asks Covered California to Close Loophole Allowing Sub-Minimum Value Plans in the Large Group Market

Health Access, along with the California Labor Federation, asked the board and staff to close a loophole in ACA regulations that allows employers to provide sub-minimum value coverage in the large group market by requiring any plan that participates in Covered California to offer minimum essential coverage in its large group products. The ACA’s employer responsibility requirements, which are foundational and critical to success of the ACA, go into effect this year.

Because of the loophole, at least one large carrier is encouraging low-wage, high turnover employers to offer “skinny” plans that offer very limited coverage. The exploitation of this loophole has several pernicious results for consumers that must be avoided. First, if an employee accepts sub-minimum coverage from their employer, they cannot enroll in Covered California and can’t take advantage of subsidies. If they get sick, they will be stuck with very high bills. Second, some of these low-wage workers will end up on Medi-Cal as a result of being offered sub-standard coverage. Health Access asked Covered California to come back to this issue at a later board meeting and amend its contracts consistent with these consumer concerns.

You can read the letter Health Access and the California Labor Federation wrote to Covered California here.

2016 Health Benefit Designs – More Work to Be Done on Specialty Drugs

Covered California also approved health benefit designs for 2016, with the caveat that further changes are needed for specialty drug designs. Health Access has asked Covered California, along with the state’s regulators, to ensure that health plan drug benefits do not discriminate on the basis of disease or health conditions, which is illegal under the ACA.

Health plans place so-called specialty drugs, which drugs designed to treat a specific chronic health condition, such as rheumatoid arthritis, AIDS, and Hepatitis C, into the highest cost tier of pharmacy benefits, which have high cost-sharing requirements that are out of reach for most consumers. When health plans apply high cost-sharing requirements to these drugs (without regard to clinical evidence, medical necessity, or reasonable medical management) while requiring lower, fixed cost-sharing requirements for other drugs, they force patients who suffer from certain diseases to pay much more than other patients.

In light of recent federal guidance that makes these practices illegal under the ACA’s anti-discrimination provisions, Covered California needs to ensure that benefit designs for the 2016 plan year comply with the law. Covered California is convening a workgroup consisting of regulators, health plans, and consumer advocates to review the specialty drug designs to insure consumer access to pharmacy treatment for chronic conditions. Health Access plans will be actively involved in this process to ensure that consumers are protected from discrimination in health care.

See Health Access’ letter to California regulators regarding specialty drug benefit design here.

Changes to Navigator Payment Policy

Covered California awarded nearly $17M in grants to community organizations across the state to help educate consumers about the benefits of coverage, helping them compare and shop for plans, and helping them enroll. Organizations receiving navigator grants are expected meet enrollment goals in order to receive their payment. Navigators have played a critical role in reaching culturally and linguistically diverse communities across the state.

Covered California and its navigator grantees have been met with some unanticipated challenges through the enrollment process. The Covered California Board adopted some changes to its Navigator Payment Policy to allow count assisted applications through plan selection towards enrollment goals and for consideration of organizations’ efforts to implement their campaign strategy. These changes will help Navigator grantees receive payment for their important work in getting Californians enrolled.

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