Covered California covers many topics…

From the discussion at today’s Covered California Board meeting, here’s a report from our Sawait Hezchias-Seyoum.

Some of the items that received the most reaction from stakeholders and Board members alike included the setting of the per member per month fee to fund Covered California’s operations at $13.95; the proposal to consolidate Outreach & Education and Enrollment programs; and a proposal to require paper verification as a condition of enrollment during the special enrollment period. There was considerable debate around the pros and cons of both proposals.

The majority, if not all, advocates spoke in opposition to paper verification, describing it as a significant barrier to enrollment. Western Center on Law and Poverty, one of the many groups who spoke in opposition to paper verification and sought self-attestation, also expressed concern with the Board’s intent to rely even on electronic verification, reminding the Board that 900,000 Medi-Cal applications have yet to be processed due to issues with the electronic verification system. Various health plans, from Kaiser to Blue Shield to Health Net spoke in support of paper verification, describing it as a way to prevent inappropriate utilization of special enrollment periods.

On the proposal related to consolidating outreach education and enrollment programs, the staff’s recommendation was to move away from a per application payment structure and use the navigator structure, which is a grant based structure. According to staff, approximately $10-$13 million dollars would be saved if the Board moved to consolidate these programs. Additionally, the staff proclaims, making such a change would improve enrollment efforts, allowing Covered California to better target low enrolled groups. The majority of stakeholders who weighed urged the Board to take careful consideration before making a big change. Concerns were raised around the intent to limit the function of navigators to enrollment, with advocates stressing education as a in important and necessary component.

Other important announcements included the clarification that individuals with COBRA coverage are eligible to apply for Covered California through July 15th, which is consistent with what the federal government is doing. Additionally, staff is preparing a report on the potential impact of the rate regulation initiative for the Board that will be ready before the August board meeting.

In another description of the process, Lee, indicated that health plans would be submitting their initial bids for plans and rates next week, which would then start negotiations–leading to a public release of those rates in late July.

Also during today’s board meeting, Peter Lee announced that Covered California has been working with the Department of Managed Health Care to ensure network adequacy and timely access. Peter also explained that Covered California is doing their own site visits with plans. Peter referenced that there have been over 1,100 DMHC complaints about access to care, and he reassured the group that these cases continue to be resolved and an increasing number of plans, including Anthem Blue Cross, HealthNet, and Blue Shield, are working to expand their networks, in some cases by more than 60%

Since January, there have also been 200 continuity of care cases, most of which were from pregnant woman who were in their third trimester and wanted to stay with their current physician and others from individuals undergoing chemotherapy who also wanted to resume treatment with their current physician.

The next meeting will be in June. There will not be a board meeting in July.

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