Covered California April Board Meeting

April 21, 2014

Fresh off of last week’s enrollment announcement (1.4 million in Covered California! 1.9 million in Medi-Cal!), the Board of Covered California met to discuss the first open enrollment period and preparing for round two. Here’s a review of the take-aways.


Covered California enrollment exceeded base projections by 105% and enhanced projections by 43%. Every geographic region, age group, and ethnicity exceeded expectations, with many groups doubling base projections.

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Preliminary data shows that consumers enrolled through a number of avenues. A majority of Asians enrolled via insurance brokers, while African Americans were more likely to enroll themselves. Caucasians and individuals of mixed race were the least likely to seek enrollment assistance through certified enrollment counselors. Latinos enrolled across the board, with 42% self-enrolling, 28% working with agents, 20% through enrollment counselors, and 8% through the call center. Although intriguing, take these findings with a grain of salt, considering nearly 327,000 consumers enrolled without reporting their ethnicity.

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Patient Access to Care

Covered California plans to monitor and assess access to care closely. While the Exchange required plans to meet quality and access standards, a number of concerns about provider networks have been voiced. Potential issue areas include accuracy of provider directories, timely access to providers (including “hot spots” in rural areas and Alameda), and overall confusion surrounding networks. Some insurance carriers made very significant changes to their networks from pre-ACA plans and this has caused some concern. A team of 50 employees is offering customer support to work through access problems. The plans are working with Covered California on this issue and some have expanded networks to accommodate new members.

To explore the extent of access issues, Covered California is considering conducting random testing of provider directories, requiring the plans to further prove the adequacy of their networks, additional consumer satisfaction surveys, and/or standardization of network rules and cost sharing. Additional information is forthcoming with the CAHPS member surveys, data from the plans, and IT and analytics improvements.


Projected FY 2013-14 spending is 16% or $60 million higher than as adopted last June, largely due to the necessary increase in staffing at the call centers. The preliminary budget for FY 2014-15 allocates more money to the service center, plan management and evaluation, and SHOP, while less funding will go towards CalHEERS, as some of the costs will be covered by other departments.

Outreach and Enrollment Assistance

Covered California is exploring shifting the compensation structure for the in-person assistance program from $58 per enrollment to a grant-based program. The staff and Board are also considering merging the currently siloed outreach, education, and enrollment activities and funding streams to streamline programs and reduce administrative costs. These proposals will be explored at the next two board meetings.

There are now 5,598 certified enrollment counselors and 12,236 certified insurance agents. Two rounds of payments for Covered California enrollment assistance have now been mailed; future payments will be made every two weeks, while Medi-Cal enrollment payments are not expected until summer.

Benefit Design

The final benefit designs for plan year 2015 were approved by the Board. As mentioned last month, there are few changes to the standardized benefit design. Most notably is the addition of an embedded dental product for both child and family plans.  All tiers except for Platinum will see small changes, most of which decrease out-of-pocket costs to consumers. Those who qualify for a Silver 73 plan with modest cost-sharing subsidies will see a $100 increase in the deductible and a $5-10 increase in copay for brand drugs.

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The full meeting materials are available on the HBEX website.