Covered California

Covered California helps California consumers and small businesses shop for and buy affordable, comprehensive health insurance.

CPEHN successfully advocated for provisions in the new law for Covered California to provide interpreters and translated materials. For updates on health care implementation bills that we are closely monitoring go to CPEHN’s California Legislation page.

The Latest Covered California News

Updated 3/17/2016

Covered California Sees Strong Enrollment Numbers in 2016: Covered California released a breakout of its 2016 enrollees at its February Board meeting. Nearly 440,000 new enrollees had selected a Qualified Health Plan (QHP) as of February 6, 2016. Low-income (88%) and communities of color (66%) continue to represent the majority of Exchange enrollees with Asians at 20%, Pacific Islanders at >1%, Black or African-American at 4%, Latino at 36%, American Indian or Alaskan Native at > 1%, and multiple races/other at 7%.

While Covered California’s preliminary enrollment numbers are strong, they provide an incomplete picture of the enrollee population, as close to one-third of enrollees (119,510) did not respond to demographic questions. Covered California plans to provide additional data on its 2016 enrollee population including information on the written and spoken languages of its enrollees at a later point this year.

Covered California Revamps its 2017 Standard Benefits Designs: Covered California’s Board approved changes to the 2017 standard benefit designs that will encourage the use of preventive care by enrollees. The changes include lowering co-pays for primary care, mental health, rehabilitation and urgent care by $5-10 dollars in every metal tier except Bronze. Additionally the new designs will alleviate consumer confusion by removing the extra deductible and physician copay from Emergency Department services. A drug cap will also be applied after the deductible for High Deductible Health Plans (HDHP) as required by law (AB 339). In order to make these changes, Covered California raised co-pays in areas where care is accessed less frequently, including x-rays/diagnostics, imaging, and ED facility copays. There will also be increases in the Maximum Out-of-Pocket by $550 (Silver and Gold), $300 (Bronze) and $100-250 (Enhanced Silver).

Covered California Poised to Approve Quality Initiatives that Prioritize Health Disparities Reduction in the Exchange: California has the opportunity to lead the nation by ensuring that health equity is not only important but central to all of its quality improvement strategies and to the Exchange’s ability to achieve its mission of reducing health disparities in our state. As part of its 2017 contract requirements, Covered California is proposing to require health plans to meet concrete, enforceable year-over-year health disparities reduction goals in specific target areas where known health disparities exist. Sarah has a great run down of Covered California’s quality initiatives in her Executive Director article at the top of this newsletter. More detail can also be found on our blog.

Advocates Alarmed by Covered California’s Proposal to Require Paper Documentation as Proof of Eligibility During Special Enrollment Periods (SEP): Advocates raised concerns at February’s Covered California meeting over a new proposal to require paper documentation for all Special Enrollment triggers except the loss of Medi-Cal coverage. A special enrollment period is a period outside of an open enrollment in which an individual can get health insurance coverage due to qualifying life events such as a change in family status, job loss, or birth of a child. Currently individuals can self-attest to these qualifying life events thereby making it easier to enroll in health coverage. Health plans however are asserting that because of this policy, some enrollees with high health care needs are unfairly accessing coverage. According to its own estimates, Covered California’s proposed new paper documentation requirement could bar as many as 10-15% of enrollees from accessing coverage through special enrollment in Covered California. This policy will be especially onerous for low-income communities of color and Limited English Proficient (LEP) who may be unaware of the rules and/or have difficulty locating and mailing in the necessary documentation to keep their coverage. Advocates submitted a sign-on letter and testified to the Board in opposition to this onerous proposal. In response, Covered California has proposed to include consumer advocates in discussions on the SEP proposal and proposals to address consumer barriers such as allowing electronic verification in place of paper documentation of special enrollment events. Covered California staff will bring the final process back to the Board in April for action, with the anticipated start date of 6/1/2016.

Past Covered California Updates