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Health Equity Forum: Covered California Update – July 2015

Covered California Update

On June 18th, Covered California’s Board voted unanimously to approve a $335 million budget for the 2015-16 fiscal year. The spending plan includes a 15% reduction, primarily from the outreach and sales division. The reduction comes as Covered California enters the final year of federal establishment funds, after which the exchange must be financially self-sustaining.

Positive developments in the approved spending plan include an increase of $375,000 to the Health Consumer Alliance (HCA), a partnership of legal services organizations that provide one-on-one hotline and in-person consumer assistance enrollment and appeals. Covered California had proposed deep budget reductions to the HCA partnership even as consumers continue to rely on these critical legal services. Additionally, the Board voted to increase funding for the Navigator program, up to $13 million from the $10 million initially allocated, after stakeholders, including CPEHN, demonstrated the importance of these outreach and enrollment resources.

A new study by the Kaiser Family Foundation found that Covered California’s 1.3 million enrollees are a more racially diverse mix of enrollees than those with private coverage. This makes it even more important to ensure continued funding for Navigators and legal service providers who serve these populations.  On a positive note, the budget includes funds for two new positions to analyze enrollee and claims data as part of Covered California’s efforts to reduce health disparities. A job description is available on their website.

At the Board meeting in May, Covered California approved a compromise proposal on Tier 4 specialty drugs that are used to treat chronic conditions. Under the new plan, Tier 4 specialty drugs which have the highest cost-share would be capped at a maximum of $250 for Silver, Gold, and Platinum plans and $150 for Silver 87 and Silver 94 plans. (Note: Silver 87 and Silver 94 have a ‘value’ of a Gold or Platinum level plan at a Silver level price due to the additional cost-sharing subsidies available to enrollees).) Specialty drugs in Bronze plans would be capped at a higher rate of $500. Advocates, including CPEHN, rallied for a $200 cap on specialty drugs for all metal tiers, including the Bronze plan, to protect individuals enrolled in the plan who may not realize they need this additional level of coverage. With this new policy Covered California becomes the first health exchange to approve rules to help consumers get the medications they need to fight HIV, AIDS, diabetes, hepatitis C, and other chronic conditions.

Covered California’s next Board meeting is scheduled for August 20, 2015