Covered California August Update

August 26, 2013

Covered California has made significant progress in preparing for the launch of open enrollment October 1. Below is a summary of the activities reported at the Covered California Board Meeting on August 22.

Executive Director’s Report


  • CalHEERs expected to be live and operating October 1.
  • CalHEERs is now open to agents; almost 5,000 have registered. There were some issues with logins but those have been resolved.
  • Enrollment entities and assistors will be able to create accounts in September.

Service centers

  • 93% of staffing is complete.
  • The call center lease has been signed in Fresno.
  • 2 out of 3 of the centers are training now and will be ready to answer calls, chat, & email October 1.

Training and grants

  • Over 1,700 people trained through outreach and education grants. Outreach activities are underway.
  • $3.1 million in provider outreach grants was issued to 4 organizations to conduct outreach to healthcare providers from September to December.
  • Registration for trainings for enrollment entities and assistors will begin in late August.
  • Counties are already training eligibility workers. Covered California has “trained the trainers” so that the counties can train their own workers.
  • The Navigator program has been pushed back to June 2014. Stakeholders are concerned about this, as some smaller organizations are reluctant to take on the liability and responsibility of being enrollment entities and would rather be navigators.
  • Covered California expects 500+ partnerships with organizations including outreach & education grantees, enrollment entities, etc. by October 1.

Advertising and marketing

  • Ads will be tested in September in Sacramento, San Diego, and Chico. Statewide ads will run starting in October.
  • Ads will focus on branding for Covered California in October and enrollment in November.
  • TV, radio, and miscellaneous mediums will be pursued.

Bridge plans

  • The application to create Bridge plans has been submitted to the federal Department of Health and Human Services. Their decision is pending.

Quality ratings (QRS)

  • The ACA requires the exchanges to provide information on the quality of plans. There are ratings available but not necessarily for the same network as plans offered in the Exchange.
  • Covered California is determining what level of overlap in network is acceptable for comparison and asking the plans to provide that data.
  • It is unclear when QRS for Covered California plans will be available, but January 2014 is the earliest date. Some plans may not have a rating available next year due to limited overlap in networks.
  • Several board members and various stakeholders pushed for accurate information to be made available as soon as possible.


Standard Plan Design Regulations

  • Approved

SHOP Regulations

  • Overview given but no action requested.
  • Present rules would require employers to provide an employee roster that includes every employee’s social security or tax ID number.
  • No final rule right now on how long employer imposed waiting periods can be.
  • Employers can offer cover to employees working between 20-29 hours a week.

Plan-Based Enrollment Regulations

  • Overview given but no action requested.
  • Insurance companies concerned about the difficulty of meeting some requirements like providing documents in all languages, website to those with various disabilities.
  • Prohibited activities include door-to-door marketing and cold calling.

Enrollment and eligibility regulations

  • Vote declined.
  • Number of regulations proposed addressing very complicated matters. The board was unable to read and understand the regulation package in the time frame allotted.
  • There is still a fair amount of disagreement with stakeholders regarding multiple issues.
  • All family members must be in the same plan unless the children live elsewhere, custodial differences, etc.
  • Covered California will rely on consumer attestation when the federal hub isn’t available.
  • These regulations will be an action item September 19, then the Office of Administrative Law will have 10 days to approve or reject the package. If the board doesn’t approve in September or OAL rejects, then the regulations will be “underground” and unenforceable come October 1 – particularly an issue with appeals.
  • These regulations will need to be revisited considering stakeholder discussions and as additional federal regulations come out.

Quick sort

  • Approved
  • Protocol for assessing Medi-Cal vs. Covered California eligibility and delegating to the counties. When consumers call the Call Center, the customer service representatives will ask brief questions to assess household size and income. If they are found to be Medi-Cal eligible, then a warm handoff to the county eligibility workers will occur.
  • Counties will be held to same quality standards as Covered California – 80% of calls to be answered in 30 seconds with no busy signals. There is an accountability process for quality improvement.
  • The monthly volume expected is 110,000 calls, with 1/3 being quick sorted to the counties.