Covered California August Board Meeting

August 24, 2016

After a month-long break, the Covered California Board reconvened for its monthly meeting on August 18, 2016. Covered California provided updates on media coverage and enrollment numbers for Covered California for Small Business (CCSB). Board members approved readoption of the requirements for the certified application counselor program and individual eligibility and enrollment regulations. Covered California provided updates on its application for a Section 1332 federal waiver under the Affordable Care Act (ACA) and signaled its intent to adopt the final application at the September board meeting. Finally, the Board discussed draft CCSB eligibility and enrollment regulations with action to be considered at the September meeting.1

Covered California in the Media

Executive Director Peter Lee announced that Covered California continues to target hard-to-reach populations through diverse media outlets, including media focused on the LGBTQ community, and ethnic communities, such as Latinos and Asians. Some of the media outlets utilized by Covered California are San Diego’s LGBT Weekly, La Opinión, Los Angeles Sentinel, Hispanos Press and local Chinese-language news channels. Covered California affirmed its commitment to maximizing enrollment of California’s diverse communities

Covered California for Small Business

Peter Lee provided a membership, sales and operations update for CCSB. CCSB has 3,838 groups enrolled, covering 28,964 members. In terms of new business sales, Covered California reported they are at 128% of their year-to-date membership goal with a large increase (230x) in in-bound leads. (An in-bound lead is potential business that results from satisfied CCSB clients recommending CCSB to others.) Finally, Covered California reported CCSB’s operational metrics: setting up groups in three days (99%), invoicing a new group within three days (100%) and resolving account maintenance issues (93%).

1332 Waiver Update

Covered California presented a draft of the §1332 ACA waiver for review and public comment. The waiver seeks to allow undocumented immigrants to purchase unsubsidized health coverage through Covered California. If the waiver is approved, undocumented individuals would be able to buy their coverage from California Qualified Health Plans (CQHPs) offered on the Exchange. CQHPs will be exact mirrors of the Qualified Health Plans (QHPs) currently offered on the Exchange, but would not be subject to the ACA citizenship requirements. Currently, undocumented immigrants can only purchase health coverage off-exchange.

Covered California’s draft application revealed that the State’s proposal meets all the requirements set out by the Centers for Medicare and Medicaid Services (CMS) for a successful waiver. For example, Covered California held public meetings to discuss the waiver and met the “guardrails” as prescribed by CMS for state waiver requests. The guardrails include satisfying certain rules on enrollment, affordability, comprehensiveness and deficit neutrality. Covered California retained experts from the University of California Berkeley and Los Angeles to conduct independent analyses and ensure that the waiver met all requirements.

Public comment on the waiver is due September 6, 2016 by 5:00 p.m. Covered California plans to submit the final waiver to CMS in mid-September. Covered California’s detailed timeline is below. At the September board meeting, Covered California will ask the Board to authorize the submission of the final waiver.


To view the waiver in its entirety, and for details on where to submit comments, please click here. Check out ITUP’s, “7 Things to know about Covered California’s §1332 Waiver,” for more information on the waiver.

Remote Identity Proofing Regulations Readoption

The Board approved remote identity proofing regulations for the Exchange. Remote identity proofing allows applicants to verify their identity through questions generated from the federal data services hub run through Experian. The new regulations include additional forms of identification verification.

Certified Application Counselors Emergency Regulations Readoption

At the June board meeting, the Board discussed and heard public comment on the role of certified application counselors (CACs) and their responsibilities. At this meeting, the Board adopted revised regulations that add the following requirements for CACs:

  1. CACs must to refer enrollees to the appropriate channels for grievances, complaints or questions
  2. CACs must inform enrollees that they are not a tax advisor or attorney and provide enrollees with referrals to resources for tax advice and premium tax credit reconciliation, and
  3. CACs may give only nominal gifts to enrollees for purposes other than enrollment.

Individual Eligibility and Enrollment Regulations Emergency Readoption

The Board considered and adopted new eligibility and enrollment regulations for the individual exchange, which includes a change to special enrollment period rules. Special enrollment allows individuals to apply for coverage outside of the annual open enrollment period if they experience life changes such as marriage, divorce or loss of a job. The new rule requires a person applying for coverage because of a permanent move to have minimum essential coverage for one or more days in the 60 prior to the move, in order to be eligible. The rule does not apply to those moving to California from outside a U.S. territory or for someone that is newly eligible for federal subsidies from a non-Medicaid expansion state.

Regulations Emergency Adoption

The California Legislature authorized Covered California to make emergency rulemaking decisions for eligibility and enrollment regulations for CCSB through January 1, 2019.

Covered California presented and discussed new CCSB enrollment and eligibility regulations, and heard public comments. Covered California proposed changes as presented at the meeting are below. Action by the Board will take place next board meeting.


Covered California’s next board meeting will be September 5, 2016. For all material from this meeting, please go here.


[1] Covered California has a general practice of noticing an item for review and public comment prior to scheduling the item for action at the following board meeting.