Covered California September Board Meeting

September 22, 2014

This month’s board meeting jam packed a lot of material and somehow got out early. Here are the take-homes:


About half of the individuals who received notices to verify their immigration/citizenship states have successfully done so. Covered California will continue to contact consumers with outstanding inconsistencies; however if they fail to provide documentation then coverage will be terminated on October 31 (although if the inconsistencies are resolved by the end of the year, coverage can be reinstated and made retroactive). A hotline has been established to help consumers with this issue and CECs and agents can assist as well.

Executive Director Peter Lee acknowledged that glitches have led to some individuals being dropped early from Covered California plans after electronic income verification showed they are Medi-Cal eligible. This left some without coverage, however Covered California is working to resolve the issue. See today’s LA Times article for more details on this issue.

Preparing for Open Enrollment

Once open enrollment kicks off, CalHEERS is expected to be able to process consumers’ first premium payment. This is big news, people. That means significantly less confusion amongst carriers and consumers about when bills are due, how they can be paid, and when coverage starts.

Another new addition to the enrollment: voter registration. All consumers will get the opportunity to register to vote during the application process, and agents and CECs must assist. Additionally, regulations were adopted that forbid all enrollment workers from offering cash or gifts, as well as unsolicited (e.g. door to door) enrollment assistance.

You may have noticed commercials have already started airing, prepping consumers for open enrollment, which is just around the corner on November 15. The new ad campaign is just one part of the multi-touch outreach strategy that mixes various marketing and media forms and will appeal to consumers using a variety of messages. More details can be found here.

Network Adequacy Analysis

The Exchange is kicking off an analysis of network adequacy amongst plans using provider data from the plans as well as a look at Covered California’s policies on networks. Right now Covered California is not particularly prescriptive with the plans, although it is incorporating policies regarding essential community providers and access to care in medically underserved communities, but the Board expressed willingness to readdress this approach if the network analysis shows demonstrates access issues.

Unfortunately, due to the staggering list of competing priorities, Covered California will not have a searchable directory of all providers participating in all plans available upon the launch of open enrollment. The website will have links to each carrier’s directory, which are updated at least weekly, but consumers will have to do their homework to research which doctors participate in each network.

Navigator Program

The Navigator grantees have been selected – a total of 227 organizations (including subcontractors). Many of these organizations are current Outreach and Education grantees that are transitioning their funding to the Navigator structure or are top-preforming Certified Enrollment Entities. A total of $17.7 million was awarded (including $3 million in Outreach and Education funds) and more than $2 million will be available as bonus payments for organizations that outperform expectations. It is expected that more than 93,000 individuals will be enrolled and effectuated through the Navigator program, with a focus on underrepresented communities.

Screenshot 2014-09-22 15.24.45

Quality Management

The Quality Rating System (QRS) will stay essentially the same in 2015 as it was in 2014. While the CAHPS scores have been updated, they still do not reflect data on Exchange enrollees – this will not be available until 2016 at earliest. A few tweaks were made to calculate ratings for carriers that offer both HMO and PPO products and for new EPO plans that were not previously available, but the scores come out exactly the same as in 2014.

Proposition 45

The Board voted not to take a formal position on the Proposition as an organization or whether to allow board members to use their titles when taking personal stances, citing the need to stay above politics.

As always, the full meeting materials are available here. Next month’s board meeting may be rescheduled and combined with November’s – stay tuned.