Kevin Knauss: Health, History, Travel, Insurance
Under the leadership of Dr. Oz, Medicare is rushing to implement Artificial Intelligence (AI) to review, authorize, or deny health care services received by Original Medicare beneficiaries. The primary goal is to save money not necessarily improve patient outcomes. CMS calls the new AI health care initiative “Wasteful and Inappropriate Service Reduction (WISeR) Model.
The underlying rational for the new rules is that CMS perceives consumers to be cheating the system. With no evidence presented, CMS believes that consumers are receiving subsidies and health insurance they are not entitled to. They accuse individuals, families, and agents of committing fraud. Again, they present no evidence to support their supposition. The focus of CMS is to save money and if people are denied health insurance and health care, that is simply collateral damage to achieving the goal of less federal expenditures. The new rules are meant to save money and help the health insurance companies.
The Covered California application has been updated to better recognize and process documents related to confirming the identity of the applicant. With just the information on the application (name, address, date of birth, and social security number) the system can now quickly verify the applicant. Covered California has done away with the identity proofing questions.
Upon learning that CMS or the federal Department of Health and Human Services (HHS) may have shared personally identifying information with the Department of Homeland Security, the California Department of Health Care Services asked CMS if any individual Medi-Cal member information has been shared. As of June 13, 2025, there has been no response to the inquiry.
FOLX describes their services as encompassing primary care, gender-affirming care, and mental health care. All the services and providers are attuned to the specific health care needs of the LGBTQIA+ community. In addition to virtual primary care, FOLX is a mix of patient advocacy and concierge service.
Once your application for health insurance is approved by Covered California, the clock starts ticking on the Reasonable Opportunity Period (ROP) of 95-days to submit any proof or verification requests from Covered California. If they do request verification for conditional elements such as income, immigration, or minimum essential coverage, they will send you a letter.
Covered California has estimated that 112,000 individuals will lose the health insurance subsidy under the proposed Republican budget reconciliation bill now under consideration in Congress. Language in the bill would prevent lawfully permanent residents in close to 40 categories from receiving the Advance Premium Tax Credit subsidy to lower health insurance premiums. Republican bill to […]
Except for a few qualifying life events, you have a 60-day special enrollment period window to enroll in health insurance from the date of the event. The qualifying life events listed below are of May 2025. Proposed rule changes by the Trump administration may mean some events are no longer eligible for the special enrollment period.
The management of websites, especially as large and complicated as Covered California, requires professionals that understand all the code, trackers, cookies, and tags. It is surprising that the Covered California IT team missed the tag that was gathering personal information and sending it to LinkedIn.
President Trump has instilled fear and caution in consumers applying for health insurance. Some consumers are skipping over optional questions that pertain to ethnicity and gender identity fearful their responses may be used against them in the future by the Trump administration. I agree with them.
