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Covered California Website to Verify Medi-Cal Eligibility

covered_california_calheersCovered California hosted another webinar to provide a progress update of the California Healthcare Eligibility, Enrollment and Retention System (CalHEERS) website. In short, this is the website Californians will use to enroll in one of the qualified health plans offered in their area through Covered California. There will also be paper applications and call center telephone enrollment available. June 18, 2013: CalHEERS System Demo Webinar

Covered California makes progress on enrollment website

In this latest report on the CalHEERS website being built by Accenture, they have added some of the features requested from earlier reviews and have clarified some of the options for enrollment in the different plans. Specifically, the website is now demonstrating the functionality to identify children that are eligible for Medi-Cal within a household. In addition, they have the capability to search for doctors to match with available plans.

Medi-Cal eligibility can be confusing

Under the Affordable Care Act and the state health insurance exchanges that allow people to qualify for the Advance Payment Tax Credit to lower their monthly premiums or Medi-Cal, some of the income and household rules can get confusing. For household incomes between 138% and 250% of the Federal Poverty Line, children in the family automatically qualify for Medi-Cal. The income eligibility is similar to the Healthy Families program that is being phased out.

Integrated options will smooth enrollment

When filling out the household and income portions of the CalHEERS website, the system automatically takes the information and applies the Medi-Cal designation to the children. The diversity of households where different members are eligible for different types of health insurance (Medi-Cal, Medicare, VA, employer sponsored, etc.) was illustrated with questions asked of Ken Wood of Covered California in a recent Live Chat about the health insurance exchange.

CalHEERS website still under construction

The functionality of the CalHEERS website to automatically make determinations and provide the necessary information will be huge benefit for families navigating through the health insurance options. Because the webinar was a high level overview, not all of the steps or options were featured. However, there will be some families that even though their children are eligible for Medi-Cal, will prefer to enroll them in a regular health insurance plan. I would assume that some sort of “opt out” feature will be built into the program.

Matching the docs to the plans

Another great bit of functionality that they have built into the system is the ability to enter doctors and hospitals as a preference in selecting a health insurance plan. The ability to match current doctors with the health plans will go a long way to ensure enrollment satisfaction. Along with a section on anticipated health costs derived from the applicants answers to questions such as how often they see a physician and their prescription medications, the Smart Sort function of the program will display those plans that have the highest number of selected doctors in the network and minimizes expenses.

Who doesn’t want help?

The only odd part of the design was a question early in process asking if the applicant wanted help paying for the health insurance premiums. The Advance Payment Tax Credit that helps reduce the monthly health insurance premium is calculated when the applicant enters the annual income. Perhaps because I am following the site design and program to carefully the question of asking people if they want help so early in the process seems out of place to me. But I understand that they are trying to remind people that help is available and even relatively solid middle class household incomes may see some tax subsidy.

The way the CalHEERS enrollment website of Covered California is developing, some of the health insurance companies may just want to license a copy of it to help people searching for plans outside of the exchange.

Below are some of the screen shots of the CalHEERS website under development. Click on thumbnails to enlarge

Proposed Covered California welcome screen on options

Proposed Covered California welcome screen on options

 

Proposed CalHEERS household list

Proposed CalHEERS household list

 

The ability to select relationships to verify household

The ability to select relationships to verify household

 

Special questions to verify immigration status eligible for coverage.

Special questions to verify immigration status eligible for coverage.

 

Website will give income summary and allows for edits.

Website will give income summary and allows for edits.

 

Covered California will automatically trigger eligibility for children for Medi-Cal

Covered California will automatically trigger eligibility for children for Medi-Cal

 

Medi-Cal Confirmation is great information about the process.

Medi-Cal Confirmation is great information about the process.

 

Enrollment page highlights which family members need to select health plan.

Enrollment page highlights which family members need to select health plan.

 

Estimating healthcare costs helps identify best fit plans.

Estimating healthcare costs helps identify best fit plans.

 

Doc find is a great feature that is important.

Doc find is a great feature that is important.

 

Smart Sort give best plan options based on costs and doctor preference.

Smart Sort give best plan options based on costs and doctor preference.