California Health Exchange Board Meeting – 9/19/13

Just a few days before open enrollment which begins October 1, 2013, the California Health Benefit Exchange Board met today with an open session that began shortly after 12pm and ended before 5pm.

The big news was the announcement that the online portal and IT system is ready to go for an October 1 launch, and many, many package of regulations adopted also for that launch date. At the same time, it was clear that ongoing work would be going on to build additional elements for January and into 2014, from quality ratings to Medi-Cal plan selection to supplemental vision to more options for the unbanked.

Peter Lee started the meeting off with a quick review of the closed session – the Board took action on a range of contracting matters, approved outreach grants for the California Medical Association and California State University of Los Angeles and approved a lease in Oakland which will be used to house some off-site staff.

Before moving on to his Executive Director’s report, Peter Lee engaged the Board and the audience in a light moment, wishing fellow Board member Dr. Robert Ross a very Happy Birthday. Dr. Ross expressed his gratitude, thanking Peter, but said the biggest birthday gift he could think of was the news that the CALHEERS IT system seems to be up and running and ready.

Today’s Executive Director’s Report was quite extensive, encompassing 10 discussion items.  Peter began his report by revisiting Covered California’s Vision and Mission Statements that he stated were the board and staff’s guideposts, as a prelude to this last meeting before the launch of open enrollment.

Highlights from today’s Executive Director’s Report:

Two Covered California commercial ads, one in English and the other in Spanish were shown. Both ads will air beginning October 1, 2013.  These ads have been running in some test markets in Chico, Sacramento, and San Diego.  According to Peter, the response to these ads has ben significant, with increasing call volumes and pick-up on social media.

The Historic Launch of Covered California Open Enrollment:

Covered California will host multiple press events throughout the state on October 1, 2013.  Covered California will be working with various partners, educators, stakeholders and community members in this launch.  Additionally, ads will begin running in all California markets.  Paid media program will cover state geographically and demographically via broadcast print and other media.

Insurance Coverage in California On the Eve of Coverage Expansion:

The majority of people have employer based coverage, so nothing will change for these people who make up 53% of the population, or others on Medicare or other public programs. Of the remaining population, 2.6 million are eligible for premium assistance, 1.4 million are newly eligible for Medi-Cal, but more currently eligible who will benefit from streamlined enrollment and another 2.7 million are not eligible for subsidies, but for individual coverage with guaranteed issue and new consumer protections.

During the Executive Director’s Report segment, Toby Douglas, Director of DHCS discussed the work that DHCS is doing around outreach and marketing, including the work to transition 600,000 LIHP enrollees into Medi-Cal by January 1, 2014. Toby added that the department’s ability to express lane enroll individuals on SNAP will grow this number even more.

Dr. Ross asked Toby about the department’s plan to disseminate Medi-Cal outreach dollars.  Toby expressed that the department is working on getting direction out to counties, but their plan is to work with county health departments to get the money out.  The expectation is that the county health departments will work with their community networks to develop outreach around Medi-Cal.  Toby also expressed that the Department is collaborating with Covered California to ensure enrollment counselors who enroll Medi-Cal enrollees are able to get paid through these funds.

Goals and Enrollment Forecasts:

Peter Lee stated that Covered California’s goal is to enroll as many Californians in affordable health insurance coverage as possible and provided the following forecast on potential enrollment based on historical trends in launching coverage programs and national estimates: 

  • By the end of the first open enrollment (4/1/14), the forecasted enrollment is 487,000 to 696,000 subsidy-eligible Californians. 
  • By the end of the second open enrollment (1/1/15), the forecasted enrollment is 840,000 to 1.2 million subsidy eligible Californians.
  • New Medi-Cal – by the end of 2014, Covered California forecasts that 1.1 million individuals will be enrolled into Medi-Cal of which (700,000 newly eligible and 350,000 previously eligible).

Reporting Strategy:

Starting October 8, 2013, Covered California will begin providing weekly reports on in-person and service enrollment activity.  Starting November 15, 2013, Covered California will be providing monthly reports on enrollments.

Outreach and Education:

Nearly 7,300 activities are planned for October – December; including community health fairs, cultural festivals, farmers markets, presentations at elementary and high schools, college fairs, presentations at places of worship, one-on-ones and workshops.

There’s also been active engagement with over 360 community organizations that have expressed an interest in joining the Community Outreach Network.

Enrollment Assistance: County Eligibility Workers and Certified Agents:

Covered California has implemented training for 22,000 county eligibility workers across California. Over 13,500 licensed agents have registered and over 1,200 have completed training.

CalHEERS Update:

The most exciting annoucement was by Accenture, which indicated the online portal would be ready to launch Oct 1 with full functionality for consumers to not just shop and compare but buy coverage.

Some elements will be incorporated later, including enrollment in AIM (a state-federal program for mothers and infants) and launch of automated interface between CalHEERS and county consortia systems. Later in 2014, the Medi-Cal plan selector will come online as well.

Service Center Update

The Service Center has been getting increased call volume each day, and have been handling that traffic in a timely way. Their goal even is to ensure 80% of the calls are answered within 30 seconds, 5% or less of calls were abandoned and 1% or less calls received a busy signal.

Single Streamlined Paper Application Update

Staff reported that the final draft streamlined paper application is 33 pages long, but the actual application is only three pages long per individual.  Staff emphasized that the draft application has been tested through one-on-one consumer interviews that happened in several cities around the State in five languages.

Voter Registration Assistance Update:

There will be two opportunities for people to register to vote – on the homepage and at the end of the application.

Quality Rating System (QRS) Update:

There will be no QRS info displayed at the outset of open enrollment for October 2013, but only a link to the resources at the Office of the Patient Advocate. Covered California is working to get a quality metric that is based on the new networks that are represented by the exchange plans. Covered California is working to add QRS info as soon as possible with a current target of having information displayed by January 1, 2014.  During the public comment period, Health Access expressed support for QRS ratings, commending the Board for working to ensure that QRS information is available ASAP.

Legislative Update:

Peter Lee gave a brief legislative update highlighting bills on the Governor’s desk, including SB 639 (Hernandez) cost-sharing consumer protections.

Action Items:

Following the Executive Director’s Report segment of the Board meeting, the Board approved the following five action items: Eligibility and Enrollment Regulations, SHOP Regulations, Agent Regulations, Plan-Based Enrollment Regulations and Enrollment Assistance Program Regulations.  Peter Lee suggested it might be the biggest set of regulations ever to be considered and passed in one day.

These items were carried over from the previous Board meeting where, due to significant issues raised by advocates, the decision was made to delay consideration for action until today’s meeting. This time around, advocates supported passage of the regulations and thanked staff for the signficant improvements in the packages–even while acknowledging there were areas to be tweaked in the future as these emergency regulations were to become permanent.

For example, on SHOP regulations, numerous groups expressed concerns about the collection, even non required, of ID numbers from employees–an issue they hope to revisit.

Consumers Union expressed, with respect to the Agent Regulations, there should be an emphasis that a consumer’s best interest should be the primary consideration given. Diana Dooley responded to Consumer Unions comment by suggesting that the Board move forward with making this modification today.  Kim Belshe agreed, but after further discussion, the Board agreed not to make any modifications, agreeing with Peter Lee that the Board should take action on the item as is today and consider making this modification at a later date.

Supplemental Vision Policy:

Peter started his report by clarifying that “Supplemental Vision Policy” would not be an action item, although it was discussed.

The presentation on adult supplemental vision care consisted of an overview of the different options for facilitating the delivery of vision care.  The final recommendation was for the Board to go with the first option, which encompasses delivery of vision care through a state hosted educational and enrollment referral site. 

Health Access expressed regret that vision was not considered an essential health benefit in ACA and expressed support of a state hosted delivery system. Both Health Access and Consumers Union opposed the option that would use a private trade association portal (including one that is not inclusive of all options in the market) to buy vision coveage, as advocated by vision service providers like VSP.

Single Family Plan Enrollment:

The CalHEERS system currently does not have the functionality to allocate tax credits among different family members and as a result, all members of a family must sign up for the same plan. They have proposed a suboptimal “work around” in the meantime, and Peter Lee expressed that they are working to allow family members to choose different plans and the earliest possible implementation of this fix will be January 1, 2014.

Grace Period Update:

The board discussed options for a grace period in the case that a patient missed a premium payment.

There is a three month grace period to reinstate coverage.  State law has a grace period for coverage for the first month only. Coverage will be suspended during months two and three of federal grace period. 

Enrollees may reinstate by paying full premiums due before last day of third month grace period. If enrollee reinstates coverage, the plan pays claims for covered services incurred during second and third month.

Termination for non-payment of premium is permitted if the three month grace period is exhausted and if full payment of premium has not been made.

During the public comment period, Health Access acknowledged the challenge to reconcile federal and state regulations on this issue, but emphasized that there is still a lot of work to do to understand and reconcile impacts to consumers.

Premium Payment Policy Update:

Covered California has contracted with a third party vendor and will be able to accept electronic payments through CalHEERS. Payments will be forwarded from the payment vendor directly to the plans.

For those that are unbanked, all plans will accept money orders and a combination of debit cards and credit cards. Staff expressed that considerable headway has been made on this issue, but acknowledged that there was still more work to do.

The meeting ended with anticipation for the start of open enrollment in just a week and a half.