Senate Committee on Health Informational Hearing: “The Affordable Care Act Year Two: Education, Outreach and Enrollment

On Thursday, the Senate Committee on Health, chaired by Senator Ed Hernandez, convened an informational hearing entitled “The Affordable Care Act Year Two: Education, Outreach and Enrollment”.   The hearing served as an update to legislators and the public about lessons learned from the first year of enrollment into Covered California and Medi-Cal coverage under the ACA.  Peter Lee, Executive Director of Covered California and Toby Douglas, Director of the Department of Health Care Services (DHCS) discussed current challenges experienced in enrollment and strategies being employed to improve enrollment outcomes in year two.

Toby started off and expressed that one of the biggest challenges that DHCS is experiencing is related to functionality between the two information technology systems used to process eligibility and enrollment, the Statewide Automated Welfare System (SAWS) which is used by counties to determine Medi-Cal eligibility and the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) used by the California Health Benefits Exchange. Despite challenges, Toby assured the committee, advocates and the public that some progress has been made and DHCS is working proactively with Covered California to address outstanding concerns. In particular, Toby focused on the work being done to reduce the pending applications still in the Medi-Cal backlog. Toby shared that DHCS is working on multiple improvements to the single streamlined application online that should be ready by March, the ability to deny cases in CalHEERS and also working to address the issue of consumers receiving multiple notices.  While SB 1341 (Mitchell), a bill that is now law is being implemented and offers a long-term solution to improve functionality between SAWS and CalHEERS, DHCS is also working with the counties on short term fixes, Toby shared. On outreach and enrollment, Toby shared that DHCS is working closely with counties and community based organizations to contact hard to reach populations, including African Americans and Latinos.

Peter Lee gave an enrollment update, an overview of lessons learned and challenges ahead. With regards to enrollment, 1.4 million people enrolled in health care through Covered California and out of this group 88% received subsidies. Over 2 million have enrolled into health care coverage through Medi-Cal.  Additionally, 81% of the total enrolled in Covered California, 81% or 1.1 million people have effectuated coverage and paid their first month premium.  During the special enrollment period, 200,000 signed up for coverage. This number was lower than expected: Covered California had anticipated about 60,000 people a month would enroll, but in actuality, about 50,000 people a month enrolled.  Peter shared that the Medi-Cal backlog may have impacted the progress Covered California made during special enrollment since potentially, some people who applied for Medi-Cal, but were otherwise eligible for coverage in Covered California could have applied during the special enrollment period, but weren’t able to because their applications were caught in the backlog.

Peter also provided an update of Covered California’s immigration status clearance process.  Of the 148,000 pending applications that had not been cleared due to consumers who failed to provide immigration status information, about 138,000 have been cleared.  There are approximately 10,000 consumers who have received additional notices asking for immigrations status information.  Peter Lee shared that he expects a significant number of these consumers are citizens or otherwise eligible and will be cleared for coverage as soon as they submit their immigration status information.

Both Peter Lee and Toby Douglas provided an update on the renewal process and challenges they expect.  Peter expressed that the vast majority of people who are not insured are people who have adjusted to a culture of not having coverage and as such, this is one of the biggest challenges they are dealing with as they develop their outreach and education strategies.

Toby shared the historic renewal rates in Medi-Cal; Senator Holly Mitchell responded to Toby’s statement by expressing that it was important to understand why some Californians fell off coverage so that the Legislature can be a partner in addressing the issue.

Peter closed with lessons learned. One of the biggest lessons learned, Peter shared is that people need “more than one touch”; it was more common that not that people enrolled into Covered California after hearing about coverage more than one time. Peter expressed that they will be working to ensure consumers are contacted in a variety of ways.

Senator Hernandez, Chair of the Senate Health Committee ended the first segment of the agenda by asking what it was going to take to ensure enrollment is done efficiently.  Toby (DHCS) expressed that first, it will take time and that DHCS is working on mitigating strategies for issues and challenges that may arise.  Second, it will require improved capacity of computer systems and lastly, adequate resources for counties who do enrollment.

Jim Mangia, the President and CEO of St. John’s Well Child and Family Center discussed enrollment issues related to the Medi-Cal back log.  Jim shared that St. John’s has provided care to close to 3,000 patients who have Medi-Cal applications that are pending and as a result they have experienced a loss of $2.5million in revenue.

Advocates and community organizations including Asian Americans Advancing Justice, La Familia Counseling, Community Health Councils, NAACP and Young Invincibles shared examples, stories, best practices, and lessons learned on outreach and education.  Yolanda Richardson, Chief Deputy Executive Director for Strategy, Marketing and Product Development of Covered California and Rene Mollow, Deputy Director for Health Care Benefits and Eligibility of DHCS expressed their appreciation for the partnership with the groups present and the opportunity to improve where needed.