Monday, 15 July 2024

Covered California expands special enrollment and Medi-Cal seeks waivers to encourage coverage

SACRAMENTO – As the state of California is taking action on many fronts to respond to the COVID-19 pandemic, Covered California and the Department of Health Care Services, or DHCS, joined together to make sure that those losing employment would have a ready path to coverage – whether through Medi-Cal or the plans offered through Covered California.

Effective Friday, March 20, Covered California opened the health insurance exchange to any eligible uninsured individuals who need health care coverage amid the COVID-19 national emergency.

Anyone who meets Covered California’s eligibility requirements, which are similar to those in place during the annual open-enrollment period, can sign up for coverage through June 30.

“We want to get as many people covered as possible to ensure they have access to the health care they need,” said Peter V. Lee, executive director of Covered California. “Having more people insured is the right thing to do, and this action builds on our efforts to leave no one behind in California.”

People who sign up through Covered California will have access to private health insurance plans with monthly premiums that may be lowered due to federal and new state financial help that became effective in 2020. After selecting a plan, their coverage would begin on the first of the following month – meaning individuals losing job-based coverage will not face a gap in coverage.

In addition, consumers who sign up through may find out that they are eligible for no-cost or low-cost coverage through Medi-Cal, which they can enroll in online. Those eligible for Medi-Cal can have coverage that is immediately effective.

California has put a 90-day hold on Medi-Cal renewal reviews, ensuring those already enrolled can continue their coverage and freeing up resources to quickly process the expected new enrollments.

DHCS also is seeking expanded authority to expedite enrollment for seniors and other vulnerable populations, expand the use of telehealth, and take other steps to make care easier to access.

“The extraordinary challenges posed by COVID-19 demand an equally extraordinary response, and the Medi-Cal and Covered California systems are stepping up to meet the need for health coverage and ease access to services,” said Dr. Bradley P. Gilbert, director of the Department of Health Care Services.

DHCS oversees Medi-Cal, California’s version of Medicaid, which provides coverage for about 13 million Californians.

The California Department of Managed Health Care, or DMHC, and the California Department of Insurance will provide guidance to health plans on the special-enrollment period, which will also include off-exchange health plans. This will ensure consumers enrolling in the entire individual market in California will have access to coverage during the pandemic emergency.

“We are working together to protect the health and safety of Californians during this pandemic,” said DMHC Director Shelley Rouillard. “This includes making sure that Californians are able to access health care coverage. Opening a special-enrollment period due to COVID-19 offers new coverage options to Californians when they need it most.”

All Covered California and Medi-Cal plans offering telehealth options

All health plans offered through Covered California and by Medi-Cal provide telehealth options for enrollees, giving individuals the ability to connect with a health care professional by phone or video without having to personally visit a doctor’s office or hospital.

All medically necessary screening and testing for COVID-19 is free of charge. This includes telehealth or doctor’s office visits as well as network emergency room or urgent care visits when necessary for the purpose of screening and testing for COVID-19.

In addition, Medi-Cal covers costs associated with COVID-19 in both its managed care plans and with fee for service providers. Covered California health plans will help cover costs that arise from any required treatment or hospitalization.

“A core part of our mission is improving access to high-quality health care, and that has never been more important than it is right now in California,” Lee said.

New ad campaign to get the word out

Covered California will be alerting the public about the new special enrollment period through television, radio and digital ads.

Covered California is already running ads that highlight the new financial help that is available for the first time this year, the new state individual mandate penalty and ads that make the connection to the COVID-19 pandemic and the ability to get coverage.

New state subsidies help Californians lower their health care costs

Californians who sign up for coverage may be able to benefit from a new state subsidy program that expanded the amount of financial help available to many people. The subsidies are already benefitting about 625,000 Covered California consumers. Roughly 576,000 lower-income consumers, who earn between 200 and 400 percent of the federal poverty level, or FPL, are receiving an average of $608 per month, per household in federal tax credits and new state subsidies (which averages $23 per household).

The financial assistance lowers the average household monthly premium from $881 per month to $272, a decrease of 70 percent.

In addition, nearly 32,000 middle-income consumers have already qualified for new state subsidies, with average state subsidy to eligible households is $504 per month, lowering their monthly premium by nearly half.

Many of those eligible for the new middle-income state subsidies are an estimated 280,000 Californians who are likely eligible for new state or existing federal subsidies but kept their “off-exchange” coverage. They are also eligible to switch to Covered California and benefit from the financial help.

During this special enrollment period, Covered California, its health plans and certified agents will be reaching out to these Californians to let them know how they can save money on their premiums – which will help them keep their coverage in challenging financial times.

California’s success in expanding coverage strengthens pandemic response

The policies announced today build on the success of the Affordable Care Act in California. Since the law was signed 10 years ago, California’s uninsured rate has dropped to a record low of 7.2 percent thanks to the expansion of Medi-Cal and the creation of Covered California.

“California’s policy makers made important choices ten years ago to build the Covered California exchange and dramatically expand the state’s Medi-Cal program. Those choices – as well as new efforts by Gov. Newsom and the Legislature to bolster financial support to buy coverage – mean many millions of people have coverage today and can get it tomorrow for this critical moment in time,” Lee said. “Our goals now must be to make sure we meet the needs of those without insurance – whether they just lost their coverage or lost their income – while assuring those with coverage get the care they need, when then need it. The urgency of this public health crisis calls on all of us to do everything we can to help Californians.”

Staying safe while getting help enrolling

With the just announced order for Californians to stay home if they are not engaged in essential work or travel, Covered California is working with the more than 10,000 Certified Insurance Agents that help Californians sign up and understand their coverage options through phone-based service models.

“We are in a different world right now, but social distance does not mean you cannot get personal help,” Lee said. “Our agents and staff are stepping up to help people by phone and support them to enroll online.”

Consumers can easily find out if they are eligible Medi-Cal or other forms of financial help and see which plans are available in their area by using the CoveredCA.Com Shop and Compare Tool and entering their ZIP code, household income and the ages of those who need coverage.

Those interested in learning more about their coverage options can also visit or call Covered California at 800-300-1506.

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