Covered California Celebrates for a Moment, Goes Back to Work

Here’s a report from our Sawait Hezchias-Seyoum on yesterday’s Covered California board meeting.

Executive Director Peter Lee unveiled the big number in his opening remarks at today’s Covered California Board meeting showing that California has exceeded all expectations with the stat that close to 1.4 million people have enrolled for coverage through the Exchange and an additional 1.9 million have enrolled in Medi-Cal.  Everyone alike, from the Exchange staff, health plans, brokers/agents, enrollment counselors, hospitals to health professionals, clinics, advocacy organizations, community groups and others expressed congratulations, following the release of the latest enrollment numbers.

The enrollment update provided a glimpse of what current enrollment looks, not only by race and ethnicity, but also by service channel.  With regard to enrollment by race and ethnicity, it was noted that enrollment continued to get more diverse as time progressed. For example, the data showed that in the last few weeks, Latino’s comprised 39% of enrollment, which was a jump from 18% in the first three months.  Another piece of valuable information that was revealed during the update was that certain racial groups gravitated towards a particular enrollment channel.  For example, African Americans were more likely to self-enroll, while Asians and Latinos relied on agents.

Peter reminded everyone that while we should be very pleased by the progress we have made thus far, the work isn’t over, we are now in the “special enrollment” phase. During the special enrollment period, consumers will continue to be able to apply for the Medi-Cal program and Covered California will coordinate with partners to ensure people who are eligible to enroll in coverage due to qualifying special circumstances will be able to do so seamlessly. Speaking to the 800,000 Medi-Cal applications that are pending, Peter shared that Covered California is also coordinating with the Department of Health Care Services and California Welfare Directors Association on these pending Medi-Cal cases and Medi-Cal re-determinations, in order to develop seamless processes to assist consumers who are found eligible for Covered California to enroll without a tax penalty.  Dr. Ross followed this report by reassuring the group that the board and staff will not rest until the consumer experience is as user friendly as possible.

The update on Timely Access and Care touched on a variety of concerns including, concerns around accuracy of certain plan provider directories, timely access to available providers, and confusion about benefit design regarding what is in or out of network and physician confusion regarding their network status.  Included in this report was a recommendation of additional steps that could be taken to improve access to care.  There was a push by Dr. Ross and Kim Belshe to see that these additional steps were in fact pursued.

Advocates alike expressed the importance of consumers getting the care they need when they need it and urged the board and staff to pursue the recommendations outlined in the Timely Access and Care report, and additional efforts.

Of the handful of bills that were mentioned during the Legislative Update, SB 20 is of particular importance given that it’s an urgency bill. In light of the new open enrollment period established by the federal government, SB 20 would change California’s open enrollment period so that it conforms to federal law.  California’s current open enrollment period is from October 15 to December 7th, while the new federal open enrollment period is November 15 to February 15.

Following the Standard Benefit Design update, a handful of advocates thanked the board and staff for including in their proposal, pediatric dental as an embedded product and family dental also as an option.  Many advocates expressed disappointment at the proposal to increase the medical deductible in the Silver 73 plan and urged the board and staff to reconsider. Lee reminded the audience that the plan by definition had to have a certain amount of cost-sharing, and that many services were provided outside the deductible.

Finally, the board approved the 2014-15 budget and also a 16% increase in the current year’s budget.  The increase in the current year’s budget did not come without questions from the board about why the need for an increase.  Staff explained that a significant chunk of the cost, $112 to be exact, was a result of the many changes that needed to be made to the CalHEERs system, a lot of unanticipated changes that were necessary to comply with federal standards.

The board also discussed proposals for building next year’s budget, including an increase in call center staff. Also worthy of mention is the recommendation by staff to change the method of payment on outreach and enrollment activity from a per application construct to a grant based funded program.  The board will consider this recommendation at a future meeting. However, there was a lot of support from groups for this change at today’s meetings.