30K Covered Calif. Enrollees Face Delays, Coverage Cancellation

Covered California officials said they are working to fix mistakes that caused gaps in health coverage for about 30,000 consumers, the Los Angeles Times reports.

Covered California said that about 20,000 enrollees have experienced delays or confusion over their health care coverage after the exchange did not send their applications to insurers in a timely manner.

In addition, the exchange said that about 10,000 residents had their private health coverage prematurely canceled after they were found to be eligible for Medi-Cal, California's Medicaid program.

Covered California Executive Director Peter Lee said, "There have been some cases of individuals where the wires got crossed and people were removed from Covered California before Medi-Cal was live." He added, "It's been a limited number of cases, but it's still a concern."

Update on Enrollee Verification

Meanwhile, exchange officials said that about 50,000 enrollees still need to verify their lawful presence in the U.S. or risk losing their health coverage (Terhune, Los Angeles Times, 9/22).

In July, HHS' Office of Inspector General released a report finding that the federal government and Covered California failed to properly verify eligibility for exchange enrollees, including by not always confirming U.S. citizenship.

Last month, CMS sent letters to about 310,000 U.S. residents who enrolled in coverage through the federal insurance exchange warning that if they do no submit documents to verify their citizenship or immigration statuses by Sept. 5, they could lose the coverage they purchased through the federal health insurance exchange.

The move did not affect state-run exchanges. However, Covered California officials later said the state's insurance exchange would follow the federal government's example and require about 100,000 enrollees to verify their lawful presence in the country in order to retain health insurance they obtained through the marketplace (California Healthline, 9/5).

Covered California has shifted some of the exchange's call center workers to handle the verification process, which has caused delays at the call centers, according to the Times. Specifically, the exchange found that:

• Fewer than 1% of callers were answered within 30 seconds in August, compared with the exchange's goal of 80%; and
• 64% of callers hung up before a call center worker answered.

Lee said the exchange likely will hire an outside vendor to support the call centers during peak times (Los Angeles Times, 9/22).

Narrow Network Problems Persist

In related news, Covered California has received hundreds of complaints from enrollees about narrow provider networks among many of the state's most popular insurers, the Sacramento Business Journal reports.

Specifically, the exchange has received:

• 176 complaints about Anthem Blue Cross;
• 130 complaints about Blue Shield of California; and
• 17 complaints about Health Net.

However, no complaints have been filed about Kaiser Permanente.

California Department of Managed Health Care spokesperson Rodger Butler said the agency plans to issue reports about provider access under each insurer's plan before the exchange's next open enrollment period begins on Nov. 15 (Robertson, Sacramento Business Journal, 9/22).