Covered California August 2014 Board Meeting

August 22, 2014

After the cancellation of July’s meeting, the Board of Covered California had a number of topics to address yesterday at the organization’s new offices. Here is a review:

Resolving Eligibility Inconsistencies

In line with the federally administered Exchanges, Covered California is contacting enrollees whose self reported citizenship/immigration status and income could not be verified electronically. Covered California is first attempting to rerun the self-reported information against the federal hub, then if inconsistencies remain, individuals will be contacted to provide documentation. The Exchange is still working out the details of how to contact the approximately 100,000 enrollees with discrepancies, but they will receive several notices beginning the first week of September and can seek assistance through the call center, CECs, and agents. Inconsistencies must be resolved by late September or early October, or else coverage will be terminated.

Embedded and Dental Plans

Children will have full access to dental coverage through their ‘embedded’ medical plans in 2015. Adults can gain access to dental coverage through purchasing supplemental family dental plans, although these will not be available at the start of open enrollment but are planned for early next year. These family plans duplicate coverage for kids that is already available through the medical plan, but it provides dental coverage for adults in the family and may offer access to additional dental providers.

Screenshot 2014-08-22 13.56.23

Proposition 45

The Insurance Rate Public Justification and Accountability Act (Proposition 45 on the upcoming ballot in November) has become a contentious topic in the Exchange boardroom. Staff analyzed the impact of the Proposition, if passed, on Covered California, and found that it could significantly limit the Exchange’s power to negotiate and operate, depending on how the law was interpreted and executed. The Proposition would make Covered California plans subject to rate review (which can include review of factors like price, provider networks, and numerous other plan features) by the Department of Insurance, which could interfere with the Exchange’s active purchaser role. Additionally, the timeline for rate review would not necessarily work well with Covered California’s process, in that approval of rates could be delayed into open enrollment, and if not approved, rates would revert to the previous year’s rates; each scenario causing significant disruption. Covered California and advocates expressed serious concerns that if passed Proposition 45 could throw a wrench into the success of the Exchange, causing carriers to withdraw plans from the market and prices to go up.

The Board generally agreed with the staff’s analysis, but debated about where to go from here. There was disagreement about whether Covered California should take a formal position and/or if certain board members can speak publicly about the proposition. The legality of both options was questioned, and staff will return to next month’s meeting with legal analysis and options.

Preparations for the Upcoming Open Enrollment Period

Covered California enrollees will receive notices prior to open enrollment with their projected tax credit for 2015 and options to quickly enroll. Individuals who applied for 2014 but did not enroll (and allowed Covered California to retain their information) will also receive notices that open enrollment is coming and they should update their applications.

Outreach strategies will be refocused to align resources with need, increase health literacy, and improve culturally relevant messaging. CalHEERS improvements for user-friendlessness, reducing paper verifications, and help for consumers are also planned.

Identity verification will be required for 2015. Online and via phone, this means applicants will be asked a series of questions tied to their credit history via Experian, and in person, this means showing ID to CECs/agents.
Voter registration will be included in the 2015 application.

Regulations were readopted on contracts with agents that eliminate the requirement that brokers be recertified or undergo additional Covered California training, however this may be revisited to potentially require training on Medi-Cal.

Screenshot 2014-08-22 14.49.36

Other details:

  • The Navigator grantees will be announced in early September. The application response was tremendous – with requests for grants exceeding four times the funds available.
  • SHOP plans will be announced September 15 and rates will be released November 3.
  • The call center has been staffed up recently, mostly with bi-lingual employees. Additionally, Covered California plans to issue a request for proposals for short term call center staffing during peak demand.
  • The staff has proposed that various ethnic/community-specific advisory committees be consolidated into one Marketing, Outreach, and Enrollment Assistance advisory group, with subgroups for specific communities.
  • A process has been planned for considering changes to the benefit design for plan years 2016 and beyond. Covered California will use data available to consider the impact of existing benefit designs and guide any proposals for redesign.
  • A super interesting Kaiser Family Foundation longitudinal survey revealed that 58% of the previously uninsured gained coverage in 2014. Surprisingly, the Hispanic enrollment rates were very consistent with Caucasians.

As always, the meeting materials are available on the Covered California policy website.