Jones Calls on Covered Calif. To Delay Private Plan Cancellations
California Insurance Commissioner Dave Jones (D) is urging the state's insurance exchange to hold off on canceling private coverage for thousands of residents who might qualify for Medi-Cal, KPCC's "KPCC News" reports. Medi-Cal is California's Medicaid program.
About 95,000 state residents have been notified that they no longer qualify for subsidized health coverage through Covered California. Instead, they have been determined to be eligible for Medi-Cal based on changes to their incomes.
Medi-Cal coverage begins immediately for those who have had their private coverage canceled (O'Neill, "KPCC News," KPCC, 1/12).
In December 2014, Jones said the exchange was violating state law by canceling the residents' coverage, noting that health plan cancellations are only allowed for certain reasons, such as failure to pay premiums or relocation to a new area (California Healthline, 12/30/14).
Experts Say Cancellation Procedure Is Flawed
According to "KPCC News," some residents have had their private coverage terminated because of misinformation, in some cases caused by clerical errors.
Dylan Roby, a health policy professor at UCLA, said others have been mistakenly determined eligible for Medi-Cal because they used estimated incomes for 2015 in their health plan applications.
Roby said the eligibility determination process is susceptible to mistakes because Covered California must rely on tax returns to confirm the data if enrollees do not provide other verifying documents. However, the most recent available tax data are from 2013.
Jones Calls for Changes
Jones is calling on Covered California to change its cancellation procedure because of the potential for errors.
Specifically, Jones said the exchange should allow consumers to maintain their subsidized private coverage while income discrepancies are being resolved, rather than immediately switching them into Medi-Cal. Jones said that others states have similar standards.
Covered California officials say the current process is used to ensure that consumers do not experience any coverage gaps during the switch.
Exchange spokesperson Dana Howard said that consumers can appeal the decision if they think they have been wrongfully switched to Medi-Cal coverage ("KPCC News," KPCC, 1/12).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.