Covered California May Board Meeting

May 23, 2014

A number of important topics were discussed at this month’s Covered California Board meeting, with lively debate. Here are the highlights.

General Updates

  • Thousands of people are enrolling via special enrollment per day.
  • Next open enrollment should align with the federal dates (November 15 – February 15) but this is still pending.
  • Various focus groups and surveys are being conducted to identify what strategies did and did not work during 2013-14 open enrollment.

Access to Care

  • Relatively few cases of access issues have been formerly reported (200 continuity of care cases and 200 complaints to the Department of Managed Health Care).
  • Covered California is actively documenting and addressing individual problems and trends related to access to care, working with the Department of Insurance, the Department of Managed Health Care, and the plans
  • The plans have programs in place to reach out to enrollees within 30-60 days to ensure they have access to care needed.
  • Anthem Blue Cross, Blue Shield, and Health Net have added providers to their networks. For Blue Shield, 64% of doctors and 82% of hospitals that are in their full PPO network are in the Covered California PPO. Health Net has increased the number of doctors in network by 68% this year.
  • Welcome Packet is being developed that explains how insurance works and how to resolve issues, planned for June or July.

PMPM Fee Rates

  • Rates charged to the plan per member per month to fund the Exchange
  • Continuing the current levels for next year

Enrollment Assistance

Proposed Integrated Enrollment Assistance Program

  • A staff proposal would merge the Certified Enrollment Counselor, Certified Educators, and Navigator programs into an integrated Outreach, Education, and Enrollment Navigator Program.
  • $15 to $20 million in grants would replace the $58 per successful enrollment payment structure.
  • Current CEEs and Outreach and Enrollment grantees can keep their current arrangement through 2015 or transition to the new plan.
  • It is unclear if post 2015 the $58 payment structure will remain an option.
  • This proposal would save an estimated $10 to $13 million per year in administrative costs, and only awards of $250,000 or more will be issued to maximize efficiency.
  • The Board will decide next month whether to pursue the change, and if adopted, Navigator grant application would be due in late July.

Current Certified Enrollment Counselor Activity

  • A total of $1.25 million in CEC payments for Covered California enrollment have been issued.
  • A majority of enrollments through CECs were for Medi-Cal.
  • About 150 enrollment organizations were responsible for 80% of enrollments through CECs.

NORC Report

  • The National Opinion Research Center at the University of Chicago (NORC) conducted 2,000 telephone interviews on awareness of Covered California from mid January to late February, as a follow up to a baseline survey in summer 2013.
  • 79% of individuals interviewed were aware of Covered California, including 73% of the uninsured.
  • Individuals who had seen ads for Covered California were 50% more likely to enroll.
  • 58% of the people who did not enroll explored buying a plan, particularly young people, minorities, and those who speak languages other than English. Cost of plans was cited as the main reason for failure to enroll, although fewer people cited high costs in this survey compared to the baseline.
  • 20% of those interviewed said their previous plan was cancelled. 48% of these individuals said that their Covered California plan is better in quality or in price.
  • Hispanics were the least likely ethnic group to have enrolled or to seek pricing information.
  • While this information is very interesting, keep in mind that 45% of enrollment occurred after the interviews were completed.


Enrollment Projections

  • The UC Berkley Labor Center updated the CalSIM model and enrollment projections for the coming years.
  • CalSIM expects about the same number of subsidy-eligible individuals to enroll in Covered California next year as they did in 2013-14, equivalent to about half of those eligible for subsidies.
  • The estimates for newly eligible Medi-Cal enrollees in 2015 have substantially increased from 1.4 million to 2.2 million.

 Screenshot 2014-05-22 14.51.45

2013-14 Demographics

  • Covered California updated the 2013-14 enrollment by ethnicity figures, including estimates of the ethnicity of non-respondents. Ethnicity was imputed by using other data reported like age, gender, location compared to Census data.
  • It also compared enrollment demographics compared to projections of the subsidy eligible. 54% of whites, 50% of Asians, 39% of Latinos, and 34% of African Americans eligible for subsidies enrolled.


Screenshot 2014-05-22 14.40.02

Special Enrollment

  • Staff proposed to eliminate self-attestation for some life events that trigger special enrollment.
  • Under the proposal, individuals who get married, move, or lose coverage due to loss of employer sponsored coverage, divorce, or death of a family member will have to provide documentation of the life event, until the events can be verified by electronic sources.
  • The board will vote on the proposal at a later meeting.

Planned Improvements

  • Add the ability for customers to make their initial premium payment immediately upon enrollment
  • Clearer language in the application and collateral materials
  • Better Medi-Cal enrollment information
  • Improved CalHEERS functionality
  • Focused media outreach to minority communities
  • More detailed trainings for in-person assisters, including more information on Medi-Cal and how to use CalHEERS
  • Expand customer service staff to reduce wait times

The full meeting materials are available on the HBEX website.