What’s Ahead for Covered California? Medium-Term Policy Considerations

October 13, 2014

Covered California has achieved great success in its first year. There are certainly needed improvements, and many are planned for the coming year, but California must not lose sight of the bigger picture. Thorough long- and medium-term planning for upcoming years is necessary to truly optimize the impact of the Exchange and address important issues.

This working set of briefs identifies policy areas Covered California should consider in its three to five year strategy and offers recommendations. Emerging issues include better coordinating Medi-Cal and Covered California enrollment, the effectiveness of the standardized benefit design in serving consumers, how Covered California can promote quality and value in its plans, and the SHOP becoming successful and self-sufficient.

ITUP recommends that:

  • Covered California incorporate incentives for implementing value-based insurance designs into the terms of participation for health plans;
  • Provide presumptive eligibility to consumers with applications pending more than 45 days, allow for self-attestation while verifications are being processed, improve eligibility systems with correct rules and procedures, and issue clear guidelines to counties and consumers on eligibility criteria;
  • Covered California maintain the standardized benefit design with minor tweaks, such as highlighting deductible exemptions and eliminating the use of coinsurance; and
  • SHOP streamline enrollment and build online portal, enhance agent involvement, expand carrier choice, offer additional services to firms, and boost enrollment through expanded firm eligibility and plan options.

Download the briefs here:

Coordinating Medi-Cal and Covered California Enrollment

Standardized Benefits in Covered California Plans

Transforming the Health Care Marketplace by Promoting Value

Optimizing the SHOP