Packed Agenda at Covered California

Forty days from the beginning of open enrollment which begins October 1, 2013, the California Health Benefit Exchange Board met today from 10am-5pm during a jam-packed session that went longer than scheduled. 

The Board took action on two items, but postponed action on other items that were originally slated for action. The Board postponed action on: SHOP Regulations, Agent Regulations, Planned-Based Enrollment Regulations, Assisters Program Regulations and Eligibility and Enrollment Regulations and Qualified Health Plan Model Contract Provisions. Those items not taken up today will be scheduled for consideration at the September 19th board meeting.


The board took the following actions:

Re-adoption of Standard Plan Design Regulations:

The Board voted unanimously to adopt the “Re-adoption of Standard Plan Design Regulations.

Covered California & DHCS Terms with Counties/Consortia for Handling Medi-Cal Callers (“Quick Sort”):

There was some contention around the staff recommendation for approval of the MOU between Covered California and DHCS, which outlines the terms with counties for the handling of Medi-Cal callers item. Kim Belshe expressed discomfort about the structure of the agreement, the standards and methods of enforcement, and the unknown implications to consumers. Belshe ended up abstaining from the vote and Doctor Ross, while saying “we’re close,” voted No. This item was approved with a vote of 3-2.

Other items got considerable discussion:


The presentation on Eligibility & Enrollment Regulations was one of the more lengthy presentations, mainly because there were over 30 different regulations that staff was recommending for action. Staff expressed that there was a lot of stakeholder feedback and that not all concerns had been resolved. Despite this acknowledgment, the recommendation was for the Board to move forward with action on this item (with the exception of a provision requiring a family to all choose the same plan–something consumer groups objected to.)

Many Board members including Bob Ross and Kim Belshe expressed discomfort with approving the Eligibility and Enrollment Regulations given the outstanding concerns, which, as raised by advocates, included treatment of domestic partners (or lack thereof), the unnecessary collection of Social Security numbers, the appeals process, conformity to state law, and other issues. While the staff and chair had indicated they would prefer to pass the regulations with a commitment to consider changes, the Board ultimately refrained from action on this item following concerns raised by stakeholders during the public comment period.


Staff gave an update on the CalHEERS system and discussed the successful launch of their first “live” experience earlier in the week which was exclusively for insurance agents who were interested in signing up as enrollers. Close to 5,000 insurance agents signed up to sell insurance products.

Staff expressed that they were confident about going live on October 1, but also expressed that there was a lot of work to be done and that they would be making a decision about an October 1 roll-out in the next few weeks, with consideration given to a phased in approach that would begin with assisted enrollment prior to self- enrollment. After the staff’s presentation, Peter Lee shared that Oregon had made the decision to start with assisted enrollment before self-enrollment and that Covered California would be making a decision on this in the next coming weeks.

Following the staff’s report and Peter Lee’s comment about Oregon, there was some back and forth from Board members on what appeared to be confusion about whether the CalHEERS system was in fact ready for an October 1 roll-out. Dr. Ross asked for clarification, Peter Lee, with Secretary Dooley and Susan Kennedy and others expressed that their understanding was that the issue was not whether the system would be ready by Oct 1, it was whether a phased-in approach would be better for consumers.


During his Executive Director’s Report, Peter Lee shared that there would be a discussion on pediatric dental during the November meeting with possible decisions being made in December, about the issue for the 2015 plan year.


Also during his Executive Director’s Report, Peter Lee expressed that there would be no Quality Rating System (QRS) information displayed at the outset of open enrollment for October 2013, but that that the intent was to have Quality Reporting for plans that meet “substantial network similarity” standard (potentially 80%) available as soon as possible for 2014. Some Board members, including Susan Kennedy and Paul Fearer pushed for the availability of QRS information in 2014. Health Access, Consumers Union, CPEHN, Young Invincibles, and other groups echoed this sentiment during the public comment period.


Staff announced that the contract for a facility in Fresno has been signed and they plan to hire 158 people to begin training in October and take calls in November. Additionally, the Rancho Cordova site opened 45 days early and is up and running, as is the Contra Costa site. Staff also announced that they have met 93% of their target for service center staff and are currently in process of hiring 158 people in Fresno. They are also working to hire management staff in Fresno.


Staff announced that $3.1 million in Provider and Education Grants would be awarded to the following four organizations that were selected as part of a competitive grant process:

California Medical Association Foundation, California Academy of Family Physicians, California Society of Health – System Pharmacists and the National Council of Asian Pacific Islander Physicians.


Staff announced and went over a revised June 2014 implementation timeline and expressed that this delay would not jeopardize the successful implementation of the program.


Staff announced that over 1,700 individuals have been trained over a seven week period that began July 8.In-language training was provided following stakeholder feedback. To date, 791 participants have passed the exam. Lastly, staff announced that the evaluations segment of the training yielded favorable evaluations from trainees.

Health Access and other stakeholders commended the staff on the work around outreach and training, but acknowledged that more needs to be done.


Health Access, CPEHN, Children’s Partnership, Western Center on Law and Poverty and other groups expressed their appreciation to the staff for working closely with them on these and other regulations, but expressed that there were outstanding issues left to be worked out. In regards to the SHOP regulations, stakeholders, including Health Access and CPEHN asked that employers not be required to collect social security numbers, only tax payer identification numbers.

The day ended at about 6pm, with progress made, but recognition of the work left to do in a short amount of time…

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