California Health Exchange Board Meeting – 6/20/13

The California Health Benefits Exchange Board, the governing body for Covered California, met Thursday, June 20 in Sacramento. As has become their custom, the Exchange board heard significant updates, made some key decisions and deferred action on an item or two.

The Board did take action on five items, including approval of the previous Board Meeting notes and approval of the 2013/14 Covered California Budget. Additionally, the Board approved a 90 day extension of the Quality Health Plan Regulations (QHP) that had been previously voted on by the Board on November 14, 2012 and approved by the Office of Administrative Law on January 17, 2013. Finally, the Board moved to approve the Covered California Program Regulations, specifically around eligibility and enrollment and the assisters program.


·         Pediatric Dental

The presentation on pediatric dental coverage resulted in what was probably one of the more heated discussions items of the day. The Covered California staff announced that “dental is different”. Recent federal guidance does not require all consumers in the Exchange to buy pediatric dental, even though it is one of the ten essential health benefits.

As Health Access and other advocates said in public testimony, this is most unfortunate. It treats pediatric dental as a supplement benefit, not an essential health benefit. It drives up the cost of pediatric dental significantly because only some families will buy dental, creating price spiral upward that will worsen adverse selection.

According to the staff, “any standalone dental plan can be purchased with any Qualified Health Plan” and “every Covered California Health Plan (is) required to partner with a pediatric dental plan.” The Exchange staff said that purchase of pediatric dental would not be required of consumers purchasing in the Exchange but would be required outside the Exchange. Pediatric dental plans and rates will be announced on June 25th.

·         Service Centers opening:

Staff provided updates on the progress toward the Service Centers opening, including pictures of office buildings. Opening of the Service Centers was delayed due to the need for legislation to authorize fingerprinting and background checks: this legislation, SB509 DeSaulnier, is now signed into law.

The goal of the Board is to have the site centers in Rancho Cordova and Contra Costa staffed by 695 people by Oct 1, 2013.  The Rancho Cordova site center will be up and running beginning July 1, 2013 on one floor and on August 1, 2013 on another floor. The Contra Costa site center will be up and running beginning August 1, 2013. Because the Contra Costa site center is a county run center, they did not experience any delays due to background check legislation pending in the State Legislature. A site center has not been identified in Fresno, but the goal is to have a site center up and running by November 2013.

They expect to be able to take general inquiries by late August and to be open for full service by October 1. Work continues on coordination with the counties for “quick sort transfers” that will hand off Medi-Cal cases to the counties.


·         CalHEERS

CalHEERS, the IT system, for the exchange is somewhat behind schedule but staff believes it will be ready to launch on October 1 to allow for open enrollment.

The CalHEERS Update and System Demonstration segment of the agenda was also informative in that it was a real live demonstration of what the “user” experience will be beginning in October, 2013.

·         Opinion Research

The Exchange heard another presentation from NORC, the National Opinion Research Center, of the University of Chicago, on effective communication about insurance concepts. This presentation is useful for any organization that will be drafting talking points, presentations, or materials for the general public in helping to understand what language works and what does not. The Exchange is systematically testing the language and concepts relevant to Exchange coverage. They found, for example, that tax credits are a confusing concept for most people and will now refer to “financial assistance” rather than tax credits.

·         Marketing and Outreach

Last month the Exchange awarded grants to community groups and others to do outreach and marketing to different communities in California. The Exchange also awarded $3 million in grants to organizations doing outreach to small business.

This month the Exchange announced that it will award the final $3 million in outreach grant funding to health professional associations so that doctors, nurses and other health professionals can be educate their patients about the availability of coverage through the Exchange. Among the organizations that have expressed interest are the California Primary Care Association which represents community clinics and the California Academy of Family Physicians.

The Exchange also announced a partnership with Sierra Health Foundation to reach the part of California north of Sacramento.

·         Eligibility and Enrollment

Numerous changes were made to the proposed regulations, mostly to simplify and streamline the process for consumers.

·         Navigator: “Enrollment Counselor”

One result of the opinion research is that consumers responded poorly both to “navigator” and “assister” so the Exchange will refer to navigators as enrollment counselors. The Exchange is reaching out to entities and individuals that provided enrollment assistance for Healthy Families to apply to become certified by the Exchange.


·         Plan-based Enrollment

The Exchange is continuing work pioneered by Health Access on encouraging enrollment in the Exchange of the estimated 600,000 Californians who today buy their own health insurance and who in 2014 will be eligible for subsidies through the Exchange. Another 200,000 are estimated to be income-eligible for Medi-Cal.

The Exchange has required carriers contracting with it as QHPs to submit proposals for plan-based enrollment to reach these Californians. Consumers will be informed that they can choose any plan offered by Covered California: this worries the carriers who fear that their customers may choose another plan. Figuring out the nitty-gritty of how to operationalize this vision, while protecting consumers’ privacy, is a real challenge but it is a happy problem to have.

·         Exchange Budget

The Exchange also acted on its own budget. Over the next year, the Exchange transitions from federal grant funding to relying on revenues raised from those who enroll. Success in enrollment is essential to the viability of the Exchange itself.

Other notes of interest:

The small employer health option plans and rates are scheduled to be announced August 1.

The Board would provide webinars on the navigator program, SHOP regulations and health benefit exchange marketing material.

During his Executive Director’s report, Lee noted a press release that was sent out today announcing the Health Exchange’s partnership with the Health Consumer Alliance to expand consumer assistance.

During his Legislative Update, David Panusch went over a handful of bills, but highlighted the passage of the Medi-Cal expansion bill and characterized it as a “historic” moment in time.

The next Exchange board meeting is August 22, 2013, in Sacramento. The Exchange will not meet in July, 2013.

Health Access California promotes quality, affordable health care for all Californians.