Covered California will gain new responsibilities in 2021 for the enrollment of terminated Medi-Cal beneficiaries and tracking individuals who have lost health insurance coverage. SB 260, signed by the Governor in 2019, will require Covered California to enroll former Medi-Cal individuals into the lowest cost Silver plan. In addition, the bill also directs health plans to notify Covered California when an enrolled member ceases to have coverage.
Health Plan Notification To Covered California
As specified by the bill, health insurance carriers must notify Covered California when an individual is no longer enrolled in one of their health plans. This could be an individual and family plan or an employer group plan. The loss of coverage could be from a failure to pay monthly premiums or loss of employment.
Upon notification of loss of coverage, Covered California will send information to the address provided by the carrier to the individual about options for health insurance through California health insurance exchange.
Some carriers, like Blue Shield of California, will be sending notices to their current subscribers notifying them of this reporting requirement and allowing them to opt out of the transfer of information
California Law requires Blue Shield of California to notify you every year that we will provide your information, including email, address and phone number to Covered California if you end your health care coverage with us. Covered California will use this information to help you obtain other health coverage. If you do not want to allow Blue Shield of California to share your information with Covered California, you may opt out of this information sharing. If you do not want us to share your information with Covered California, contact Blue Shield of California at blueshieldca.com/optout, or at the Member Services number listed on your ID card to opt out of this information sharing. Thank you.
Blue Shield notice to health plan subscribers regarding information sharing with Covered California.
Automatic Silver Plan Enrollment From Medi-Cal
The new law requires Covered California to automatically enroll individuals who have been terminated from Medi-Cal into the lowest cost Silver plan in the person’s region. The automatic enrollment is meant to prevent a gap from when an individual or family is terminated from Medi-Cal to when they enroll in a new health plan. Many people have missed the enrollment deadline and consequently either had a gap of a month or two in coverage, or missed the Special Enrollment Period altogether.
The automatic enrollment function will begin no later than July 1, 2021. Covered California will receive the information from the county Medi-Cal office, which includes income, and enroll the household in the lowest cost Silver plan with a subsidy based on the verified income. The enrollment will happen before the Medi-Cal coverage terminates. The enrolled individual or family will have until the end of the following month to make the first month’s premium payment.
If the individual or household had previous health insurance through Covered California, the exchange will try to match the household with the previous carrier. The newly enrolled members can change the plan, metal tier, carrier, or split the family up into different plans. The household can also opt out of enrollment into any Covered California health plan.