Covered California Board Meeting Highlights from October 8, 2015

With less than one month before open enrollment (November 1 – January 31), the Board focused mainly on this year’s research-driven “no wrong door” approach to maximizing enrollment and facilitating thoughtful plan selection using shop and compare tools, quality ratings, and reaching out to enrollees who look like they could benefit from enhanced silver plans with lower cost sharing.

A press conference held earlier in the day provided a glimpse of the data on current or recent enrollees and what they tell us about Covered CA’s place in the insurance landscape. Most of the individuals surveyed (85%) are staying insured, even if they move into job-based coverage or Medi-Cal. As a source of quality affordable coverage for 1.3 million currently enrolled (2 million overall since its launch) or as a way station to other forms of valid coverage, this exchange is creating a culture of coverage in California. Furthermore, as an active purchaser dedicated to standard benefit designs, it is also moving the marketplace toward better value for consumers and for the system as a whole. Covered CA would not be where it is today, says Covered CA Executive Director Peter Lee without the involvement of the community.

But still there is plenty more to do to achieve the longer range goals of Covered CA, a main platform for health reform implementation in the Golden State.

Getting Covered CA’s SHOP in Order: As More Small Businesses Move to Covered CA and ACA Compliant Plans

Following two years of sluggish enrollment, Covered CA has endeavored to beef up its small business exchange. This will be important as the small group size will expand in 2016 from 1-51 to 1-100 and as 70-80% of small groups migrate starting this January to ACA-compliant plans.  As the main source of support for small businesses’ insurance needs, agents will be pleased that Covered CA is nearly caught up on paying commissions. For them, Covered CA plans to generate leads.

Marketing and Outreach to Maximize Enrollment, Retention, and Prudent Use of Benefits

Based on marketing research and surveys of enrollees, marketing strategies are aimed at educating Californians about the value of insurance, while building brand awareness and tailoring messaging and media platforms to targeted demographic groups, including communities of color, LEP groups, and LGBT Californians (for details see Executive Director presentation).  Enrollment by race/ethnicity shows improvement, particularly for Latinos who make up 37% of the subsidy eligible population, and there is evidence suggesting that targeted communications and marketing strategies have played a role in that growth. In terms of messaging that drives people to actually purchase coverage, it’s still largely about the cost/prices, with prevention and emergency messaging also helpful. Since awareness of the penalty for going uninsured is still stronger than awareness of subsidies, messaging will bring attention to the exciting fact that 90% of Covered CA enrollees are getting a subsidy.

As in recent years, we can expect a heavy emphasis on the subsidy-eligible populations to coming year. For this group it is helpful to point out in messaging that so many current Covered CA enrollees are getting a subsidy.

Following advocates’ requests that Covered CA reach out to consumers eligible for better plans (enhanced silver with lower cost sharing) than what they had chosen plans on their own, 90% have since chosen the enhanced silver plans—much better.  Seventy percent of enrollees got help enrolling, whether through navigators, certified enrollment counselors, or agents. Such in-person assistance and dedicated service centers are vital.

Retention strategies heading into 2016 plan year include warm touch through multiple channels, maximizing auto enrollment wherever possible, and a pointed emphasis on educating consumers on the purpose of insurance. This year’s renewal process will be the first to operationalize the new non-tax filers rule: those who received tax credits but did not file their 2014 taxes are not eligible for tax credits in 2016. Testifying on behalf of low-income consumers, Health Consumer Alliance’s Jen Flory urged caution in implementing this rule: some consumers may be getting an extension or need help filing their taxes.

Quality Ratings to Be Based on Actual Exchange Enrollee Experience in Open Enrollment III

Covered CA will be the only exchange in the nation to make quality ratings available to consumers as they shop for coverage, though the platform will be limited to a small selection of satisfaction scores (one global measure of health plan quality and another global measure of care quality)—not discrete clinical quality performance measures. The latter will be made available in future years.

Noting that some health plans have very low scores—Molina, for example, has only one star and five plans have only 2 stars, compared to three last year—Covered CA will work with these plans to help them improve the quality of their services.

The Evolving Role of Insurance Agents

Thanks to strong consumer advocacy and recognition of agents’ success in facilitating enrollment, agents will play an important role in the “no wrong door” approach to enrollment and retention. They will, for example, be required to facilitate enrollment in Medi-Cal or CHIP, partnering with community-based enrollment assisters and county-based enrollers as needed. To this end, The Medi-Cal Toolkit will be updated to help them meet this critical responsibility. The agents, for their part, embrace this responsibility and another to help facilitate voter registration. The Board passed a resolution to this effect.

Just Ahead

Covered CA will host discussions on different scenarios for a Section 1332 waiver for California next month. For the health consumer advocates, particularly those looking for real coverage solutions for the remaining uninsured, these discussions will be critical. In preparation, please take a look at this from the Center on Budget and Policy Priorities.

Key Dates for Open Enrollment and Renewal for 2016

August 1, 2015 Shop and Compare Tool Includes 2016 Rates
October 7 – October 30, 2015 Covered CA sends renewal notices to consumers
October 12, 2015 Active renewal begins
November 1, 2015 Open Enrollment Begins
November 13 – November 29, 2015 Auto-renewal begins
December 15, 2015 Last day to select a plan for 1/1/16 coverage
January 31, 2015 End of Open Enrollment

Board Meeting calendar for the rest of 2015: