Latest California Healthline Stories
Notice, Grace Period at Issue in Rescission Rules
California Insurance Commissioner Dave Jones filed a cross-appeal in the ongoing fight over how to implement California’s 2010 passage of AB 2470, authored by then-Assembly member Hector De La Torre (D-South Gate). The bill, approved by Gov. Arnold Schwarzenegger, banned rescission of consumers’ health coverage except in cases of non-payment or fraud.
The rules laid out by Commissioner Jones spelling out how insurers needed to comply with the law were challenged in court by the Association of Life & Health Insurance Companies in 2011. This year, on Feb. 1, the association filed an appeal of a decision by Sacramento Superior Court judge Michael Kenny, and on Feb. 25, the Commissioner announced his department filed a cross-appeal on two different aspects of the ruling.
Jones is appealing the judge’s decision to narrow the scope of the noticing requirement. Jones also is asking for a more-defined grace period before insurers can rescind coverage based on non-payment.
Pharmacies, Not-for-Profit Groups Could Help Enroll More Californians
Covered California wants to work with retail stores and pharmacies to help make people aware of and sign up for coverage through the exchange. It also has launched a major campaign to involve community groups in the outreach effort.
Bridge Plan Approved by Exchange Board
California’s Health Benefit Exchange board yesterday approved a plan to seamlessly allow low-income Medi-Cal managed care beneficiaries to choose a health plan offered by the exchange, now known as Covered California.
The idea is to allow movement between Medi-Cal and Covered California when beneficiaries’ circumstances change, so more people can stay insured without disruption. The exchange plans to launch the program in April 2014.
Up to 840,000 Californians could be eligible for it, according to David Panush, director of government relations for Covered California.
Rating Regions Headed for Floor Debate
The debate over geographic rating regions has not ended, despite being approved by the Assembly and Senate health committees last week and by the Senate Committee on Appropriations on Friday.
Competing interests want to change it — in different ways.
At the appropriations committee meeting Friday, two groups took oppose-unless-amended positions on the six-region legislation, but were not in agreement on how to divide the geographic rating regions in California.
Officials Dispute Suggestion of ‘Wrong’ Estimate
Managed Risk Medical Insurance Board officials last week bristled at the suggestion that MRMIB somehow made a bad estimate of its budget that resulted in a $116 million general fund shortfall in the Healthy Families program. With an additional $216 million in federal money that hasn’t come to California because of the shortfall, the total deficit now amounts to $332 million, according to MRMIB executive director Janette Casillas.
Casillas, at a MRMIB board meeting last week, responded to state officials’ comments that the shortfall stemmed from a mistaken estimate for how much money would be needed for the Healthy Families program in 2013.
“Our forecasting and budget assumptions have been right on every time,” Casillas told the board. “But what has occurred here is not a challenge with budgeting or forecasting, but with the budget process itself. We know what we need, it’s not about making wrong assumptions.”
Individual Market Reforms Called ‘Historic’
Two bills in the California Legislature are reshaping the state’s individual insurance market by “fundamentally changing the rules that insurers play by,” according to consumer advocates.
Historic Week in Health Care Reform
California has been working on health care reform for years, but this week’s legislative special session had that distinctive sound of a starting gun for the last, big dash toward the Affordable Care Act finish line.
On Tuesday, when Assembly Committee on Health chair Richard Pan (D-Sacramento) convened the opening hearing for the special session on health care, it clearly meant a lot to him.
“Welcome to the first extraordinary session of 2013,” Pan said. “As you know, California has been the first in the nation to establish a health benefit exchange under the Affordable Care Act. … We are bringing California in line with the new culture of care.”
Deadline Set to End Federal High-Risk Pool
Managed Risk Medical Insurance Board officials yesterday outlined plans to deal with the federal announcement that the Pre-existing Condition Insurance Plan will not accept new applicants after March 2.
The federal PCIP program will continue to provide coverage for enrollees through the end of the year. The program will no longer be needed in 2014 when the Affordable Care Act provision that insurers may not deny coverage because of pre-existing conditions takes effect.
Janette Casillas, executive director of MRMIB, which runs the federally funded plan, said some prospective enrollees could apply for a similar, state-funded program called the Major Risk Medical Insurance Program.
UC System May End Health Care Caps, Making New Bill Moot
A bill introduced last week, AB 314 by Assembly member Richard Pan (D-Sacramento), would eliminate fiscal caps on medical care for University of California students.
UC officials said they’re considering their own internal proposal to erase the caps, which would make the proposed legislation moot, but bill author Pan said he plans to go ahead with the legislation to ensure the rule is changed.
“It’s only fair that [UC students] should have the same protections as the rest of California,” Pan said, referring to provisions in the Affordable Care Act that prohibit lifetime caps on care. Even people in high-risk insurance pools had lifetime caps lifted last year.
What Will Happen With Millions of ‘Residually Uninsured’ Californians?
Covered California, the state’s new health insurance marketplace, will add millions to the state’s insured population, while a Medi-Cal expansion will add millions more. But for all the newly insured, there still will be three to four million Californians — known as the “residually uninsured” — who remain without coverage.