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Advocates Concerned About Kids’ Coverage in Calif. Exchange Plans

California advocacy groups have expressed concerns about whether children enrolled in Covered California plans are receiving adequate care, HealthyCal reports.

Details of Concerns

Several advocacy groups have sent a letter to Covered California requesting data on the estimated 77,000 exchange enrollees under age 18 (Schmitt, HealthyCal, 4/30). The letter was signed by:

  • California Coverage & Health Initiatives;
  • Children's Defense Fund - California;
  • Children Now;
  • The Children's Partnership;
  • PICO California; and
  • United Ways of California (Advocates' letter, 3/23).

The requested information included:

  • Geographic data;
  • How many children are receiving exchange coverage, broken down by age group;
  • How many children are receiving subsidies; and
  • The types of plans selected.

The groups also asked about how the board plans to determine the quality of those enrollees' health care experiences in the future.

The groups wrote, "Although children comprise less than 6% of the Covered California population, it is important that the California Health Benefit Exchange Board has the necessary information to understand how children are served by the exchange."

The letter added, "It has been noted that some plans offered by Covered California may have narrow provider networks that may inhibit a child from seeing an appropriate provider or specialist in a timely manner."

Abbi Coursolle -- a staff attorney at the Los Angeles-based National Health Law Program, which was not involved in the letter -- said, "There are network adequacy issues overall with Covered California and pediatrics isn't immune."

Next Steps

Depending on the findings from the requested data, the advocacy groups say they plan to request specific pediatric benefit requirements for state exchange plans in the 2017 coverage year.

Michael Odeh, associate director of health policy for Children Now, said, "There will be opportunity to revisit the benchmarks and I think we'll see some legislation on the state level. The conversation is underway" (HealthyCal, 4/30).

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