Covered California November Board Meeting

November 21, 2014

If you didn’t catch our live-tweet session during yesterday’s Covered California Board Meeting, now’s the time to catch up. The quick meeting reviewed the start of open enrollment, next steps, and previewed considerations for 2016.

Open Enrollment Updates

The Covered California Bus Tour was incredibly successful and the “I’M IN” campaign is fully underway (you can even add an I’m In badge to your Facebook profile picture). The Covered California website was also recently relaunched with additional resources and information in simple terms.


In just the first four days of open enrollment more than 69,000 individuals completed an application and were found eligible for either Covered California or Medi-Cal (it took 15 days to reach this number last year!). More than 11,000 of these Californians selected Covered California plans. Looking good! Renewals are also in progress, with enrollees able to switch plans through December 15 for January 1 coverage, or do nothing and be auto-enrolled in the same plan for 2015.

DMHC Audit

The Department of Managed health Care (DMHC) released a report earlier this week detailing a survey the Department conducted of providers listed in the Covered California networks of Anthem Blue Cross and Blue Shield plans. This secret shopper survey contacted 3,272 Anthem providers and 1,360 Blue Shield doctors in June and found discrepancies between the official directories and reality. For Anthem, 13% of those surveyed claimed to not accept Covered California plans, while 9% of Blue Shield providers said the same. Additionally, 13% of Anthem providers and 18% of Blue Shield providers said that the provider listed did not practice at the listed location. About 88% of Anthem providers and 91% of Blue Shield providers reported accepting new Covered California patients. These findings are clearly troubling and Covered California has been aware of these issues. The plans have been working to correct the problems and Covered California is working to educate providers about Covered California and plan contracts. Expect a lot more work on this issue as DMHC conducts a follow up audit and Covered California continues to monitor changes.


CalHEERS has undergone a number of systems improvements but, with so many priorities, still has many on the to-do list. Voter registration and first premium payment are live! There have been some tech hiccups on renewals that are being worked on. There are a number of efforts to improve the Medi-Cal enrollment process through CalHEERS, however the programming for disenrollment from Medi-Cal is on hold until after open enrollment The next big project to go into effect is the 1095 notices, which are IRS forms detailing coverage and premium subsidies for reconciliation, that should be completed in January. In the long term, SAWS integration will be a key area is future efforts.



A competitive bidding process is coming for contracts related to consumer research, marketing, CalHEERS support, and accounting services. The Exchange extended contracts for the Consumer Health Alliance, the Department of Social Services, and the provider education grants. New contracts have been awarded to forms doing targeted, ground level outreach to the Latino, African American, and API communities.


Other issues discussed:

  • Enrollment assistance and eligibility and enrollment regulations were readopted with minimal changes.
  • The benefit design workgroup has been discussing how the standardized benefit design for plans should change in 2015. Areas of focus include increasing transparency of costs, reducing coinsurance use, and lessening barriers to care.

Next month’s meeting has been moved to December 15 and will focus on QHP issues, including consideration of whether to allow currently non-participating insurance companies to join the Exchange. As always, all meetings materials are available on the HBEX website.