By allowing ads to appear on this site, you support the local businesses who, in turn, support great journalism.
California health exchange addresses dropped policies
Placeholder Image

SACRAMENTO (AP) — The leader of California’s health exchange said Thursday that the state is trying to improve notifications to consumers whose policies are shifted from private insurance to Medi-Cal during income checks and eligibility updates.

Covered California Executive Director Peter Lee told board members that an unknown number of individuals were taken off their private health plans, then switched with no or inadequate notice to the state’s version of Medicaid, which serves those who are poor, have lower-incomes or are disabled. Lee said it’s an important issue that he takes seriously.

“There have been some cases of individuals where the wires got crossed, so to speak, and individuals were removed from Covered California coverage before their Medi-Cal coverage was live, where notices were not as good as they should be, and we’re working to improve those notices,” Lee said.

The Associated Press reported earlier this month that people who bought individual health coverage through Covered California were being dropped or transferred — often without notice — to Medi-Cal, which fewer doctors and providers accept.

Covered California said the changes are happening as it is trying to ensure that policyholders have incomes high enough to purchase insurance through the exchange.

Lee said the exchange has not resolved what happens when a person seeks reimbursement for premiums paid for a private health plan once they receive retroactive coverage from Medi-Cal.

“We’ve had consumers say, ‘Well that retroactive coverage meant that I had coverage for both Covered California and Medi-Cal for a period of time. I don’t want to pay that premium I paid for that period of time.’ These are policies, quite honestly, we’re still working through,” he said.

Covered California launched the online marketplace in October 2013 as part of the state’s implementation of the federal Affordable Care Act. The exchange, which is responsible for determining and directing Californians to an appropriate health plan, offers sliding-scale subsidies for private coverage to lower-income and middle-class people with no access to health care on the job, and directs other low-income and poor people to county social service offices for Medi-Cal.

The exchange adjusted its income eligibility scale when the federal government updated the poverty scale earlier this year. As a result, an unknown number of people near the thresholds were moved between private health plans and Medi-Cal.