Agent Medi-Cal payments delayed again

Contrary to Department of Health Care Services (DHCS) statements in their Medi-Cal Essentials webinar, agents will not be receiving any payments for assisting clients that were enrolled into Medi-Cal through a Covered California application in the near future. Recent email communication from Covered California to Certified Insurance Agents suggests thatcompensation of approximately $58 per Medi-Cal eligible individual or household would be delayed until possibly the end of 2014. Download the DHCS Medi-Cal Essentials Presentation at end of post.

Agent Medi-Cal compensation approved

There has always been a prohibition against paying any compensation for assistance to enroll an individual or family into Medi-Cal. However, Certified Enrollment Counselors were to receive $58 per effectuated enrollment application through Covered California regardless of whether the enrollment was for a tax subsidized private plan or Medi-Cal. Through a series of federal grants and California legislation, AB 82, Certified Insurance Agents were to be included in the program for Medi-Cal enrollment reimbursements.

DHCS Outreach and Enrollment

AB 82, Section 70 (Medi-Cal In-Person Enrollment Assistance Payments)

The Department of Health Care Services (DHCS) has accepted contributions by the California Endowment (TCE) in the amount of fourteen million dollars ($14,000,000) and will seek an equal amount in federal matching funds for purposes of implementing the following:

Certified Enrollment Counselors (CECs) and Certified Insurance Agents (CIAs) will be eligible to receive an enrollment assistance payment of fifty-eight dollars ($58) for each approved Medi-Cal application if the Medi-Cal applicant(s) is newly eligible (pursuant to ACA) or was not enrolled in Medi-Cal for 12 months or more (prior to the application date). Payments will be issued by Covered California.

UPDATE:Payments for in-person application assistance that resulted in Medi-Cal enrollments will start by the beginning of July 2014. The first round of payments will be made for those applications that resulted in at least one newly eligible 19-64 year old on the application. The California Department of Health Care Services and Covered California continue to refine the payment process and will begin issuing payments as soon as possible for the remaining applications that received in-person enrollment assistance, including applications with children under 19 years old.

Covered California application is the same

Reimbursing agents a modest amount to assist Medi-Cal eligible Californians only seems equitable and reasonable. When an agent is contacted by an individual the agent doesnt know if the individual, children or entire family might qualify for Medi-Cal. The agent provides the same assistance with completing the application. It is the Covered California CalHEERS program that determines Medi-Cal eligibility.

Agents provide same service to Medi-Cal eligible families

Many agents have provided similar post enrollment support for their Medi-Cal eligible clients as those in private plans. Agents have worked the phones to inquire about different plan options, in-network physicians for Medi-Cal HMO plans and called on behalf of the client to find out when they would be receiving their Benefits Identification Card (BIC)from counties that were not prepared for high Medi-Cal enrollments. Most agents realize that its just good business to provide the same level of service to Medi-Cal clients as private plan members because the Medi-Cal recipient today is a potential private plan member or a referral source tomorrow.

July payments dashed

The DHCS was hoping to start distributing the allocated funds to reimburse agents to Covered California in July (see the above excerpt from the DHCS website). But another bureaucratic snag occurred when it was realized that Medi-Cal reimbursements to agents was not specified in the agent agreement. The amended agreement with specific language authorizing agent Medi-Cal reimbursements needs to be approved by the Covered California Boardat their next meeting in August. This amendment isnt specifically referenced on the Covered California August 2014 Board Meeting Agenda, but it might be part of one of the other action items regarding agents.

Compensation late 2014

Even if the amended agreement is approved, the update about the Medi-Cal reimbursements indicates that it still might be several months before any agents receive any checks for their Medi-Cal enrollments. In addition, not all Medi-Cal enrollments will be reimbursed. The DHCS Medi-Cal Essentials said there would be no reimbursement for mixed households or for individuals who were currently on Medi-Cal or had been on Medi-Cal in the last 12 months.

Full text of the Medi-Cal payment update from Covered California

August 11, 2014, Update on Medi-Cal Commissions

Paying Certified Insurance Agents for enrolling individuals in Medi-Cal is a recent policy that was not in place at the time you signed your Covered California agent agreement.

Today our legal team is working to amend the agent agreement to retroactively pay agent commissions for individuals enrolled in Medi-Cal since January 1, 2014.

However, amending the agent agreement will take time.Covered California needs approval from its Board of Directors before state regulations can reflect this update. Both of these must occur before we can enter into an amended agreement with you.

Although the amendment is scheduled to go before our Board of Directors later this month, the process could take until November or December to complete.

We appreciate your patience as we work to amend and build this process into our system going forward. We will keep you updated as new information becomes available.

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