Covered California Getting Ready for 2015

Here’s our report on the five-hour Covered California Exchange meeting on Thursday, June 19, as written by our director of administrative advocacy, Elizabeth Abbott:

The board of Covered California continued its evaluation of the 2014 enrollment, outreach, and customer service metrics.  They also revealed their preparations for the 2015 open enrollment period which begins November 15, 2014.  They provided a clear focus on what they would change and what would remain the same in their policy and operations.

Comings and Goings.  The Executive Director and the Covered CA board expressed genuine regret that the Contra Costa Health Plan would not be participating in 2015 as a plan offering.  The Exchange said they truly valued their partnership, but that Contra Costa reluctantly made their decision based on certain provisions and limitations in the federal law.  The CEO of Contra Costa expressed the plan’s hope that their absence from the exchange would only be temporary.   Peter Lee also wished the best to Gabriel Ravel on their legal staff who has been selected by the Department of Managed Health to be their chief counsel.  Peter acknowledged his tremendous work from the beginning in making Covered CA a reality.

Customer Service.  Covered CA was pleased to announce that their Service Center was now meeting and exceeding their customer service goals of 80% of their calls answered within 30 seconds.  They are now performing at the level where they are able to answer 94% of the calls within the first 30 seconds and less than 2% of calls were abandoned as measured in June.  This improved customer service is due principally to the reduction in the volume of calls, but they still recorded more than 205,000 calls in May, and 47,727 calls through June 9.  Covered CA staff also attributed these better customer service metrics to a combination of factors including:  better trained and proficient customer service staff, the fully functioning dedicated call numbers provided for brokers, agents, certified enrollment counselors, and SHOP questions, the shift of some calls to the selected health plans, and greater efficiencies and applying what they had learned during the first open enrollment period.  However, public comments urged increased recruitment of bi-lingual staff, and re-examination of the technological language transfer capacity because when some callers asked to be transferred to a Spanish-speaking customer service representative, they were cut off.

In addition, Covered CA has done extensive research and technical evaluation regarding allowing web-based entities to enroll consumers in plans offered on the exchange.  Although there was significant interest in exploring this alternative, there were concerns about the additional costs, the specific web design and integration, and, in light of the experience during the first open enrollment period, whether the online broker entities would actually be able to reach high numbers of unique, new applicants.  Consumer advocates raised issues regarding web based entities being able to reach those with limited English proficiency, the ability to offer expertise about Medicaid eligibility, and privacy and security concerns.  The staff recommended that Covered CA use the balance of time to investigate these technical problems, choices, and costs and defer this until after the end of the 2015 open enrollment season.

Covered CA noted their accomplishment of completing the training and certifying enrollment support for consumers and applicants.  These numbers totaled 5,919 Certified Enrollment Counselors and 12,376 Certified Insurance Agents.  Both groups had significant representation of assisters who spoke Spanish and several Asian languages.

Analysis of Initial Findings of the 2014 Open Enrollment and Plan Offerings

Covered CA released early analysis of the popularity of enrollment channels and plan selections.  They included:

  • African-Americans were most likely to enroll (60.4%) through a self-service enrollment channel.
  • Asians were most likely to enroll (54%) through a certified insurance agent.
  • Latinos were most likely to enroll using Certified Enrollment Counselors (48.2%) or Plan-based Enrollers (40.6%)
  • However, some public commenters questioned these racial and ethnic differentiations based on their field experience and were anxious for further analysis.
  • The most common plans selected by new enrollees were Anthem Blue Cross (30%), Blue Shield (27%), Health Net (19%), and Kaiser (17%).  Smaller plans were also well represented in several regions.
  • Covered CA board and staff affirmed their plan to incorporate very few changes to the benefit design for the 2015 Open Enrollment Period.
  • The staff were pleased to announce that they have successfully worked out embedding pediatric dental benefits in the medial plan offerings in 2015.
  • They also announced they will offer a family dental package for purchase which goes beyond the federal essential health benefits standards for CA consumers.

Policy Issues for Discussion. . .and A Little Controversy

Covered CA is refining their approaches to consumer assistance and correlating it with “successful enrollment” tallies, efforts to reach hard-to-reach groups, and the costs associated with each.  They are facing the imperative of being able to support their operations based on premium assessments (and not federal grants) which at least have the potential to drive up premiums.  In order to assure the most efficiencies and the largest numbers of successful enrollments, they are planning to adjust and realign the outreach and marketing operations and reimbursement to assisters paid by the Exchange.  Initially, they planned to move toward combining educational and enrollment efforts and reimburse only the most successful entities who exceed a relatively high threshold of signing up consumers.  They are rethinking this reimbursement model to account for the fact that they may want to keep smaller CBOs focused on hard-to-reach applicants.  They have undertaken to revise the timetable for that reimbursement to provide up-front costs for small organizations, and further streamlining administrative requirements.  Comments from consumer advocacy organizations urged further dialogue with their groups to incorporate their field experience and consider further refinements and options.  They also pressed for fewer administrative reporting requirements.  Covered CA will continue the dialogue before adopting entirely new models.

There was a heated discussion regarding the issue of the verification needed to confirm eligibility for a special enrollment period.  Plans are leery of consumers “conveniently” undergoing a life-changing event to enable them to elect coverage to coincide with a sudden onset of a serious illness or accident.  Consumer advocates pushed for as expedited as possible ability to do a systems verification of a life-changing event (e.g. marriage, birth of a baby, loss of a job etc.) and not require the applicant consumer to furnish paper evidence.  They also questioned whether Covered CA had the staffing to examine and analyze all of these paper submissions.  This attestation procedure models what is being done by the federal exchanges run by HHS.  Consumer advocates also pointed out that consumers are attesting to these events under penalty of perjury which should be sufficient deterrent to misrepresenting their change in circumstance.  Legal advocates also argued for this conditional eligibility to remain in place for 90 days according to state law, while health plans felt 30 days would be more than enough time.  The board voted to explore these possibilities with further research, with only board member Paul Frears showing flexibility to a broader standard or proof, based on his experience with the Pacific Business Group on Health.

The final controversial topic touched on is the ballot initiative proposed for the November ballot that will give additional authority over rate review to the Insurance Commissioner.  There remained many unanswered questions regarding what that rate review authority, if approved by the voters, would do to the timing for negotiations between Covered CA and the qualified health plans.  There are further discussions planned to work out specific plans and timelines if the measure passes.

There is no Covered CA board meeting planned for July, but they will resume their monthly schedule in August.