Covered California erases a family member’s enrollment in a health plan and says they can’t find it.
I wouldn’t have believed if I had not seen with my own eyes. For months the Covered California account of a client showed one of the household members enrolled in an Anthem Blue Cross plan. Then one day it disappeared. All Covered California can say is that they don’t see the member ever being enrolled. The client continues to pay for the phantom Anthem Blue Cross that Covered California says never existed. How was this enrollment information erased?
Numerous complaints about Covered California website
Covered California has been updating the CalHEERS online enrollment application in 2015 in response to a government audit that found numerous accessibility violations and complaints by consumers groups that program glitches were preventing consumers from properly updating their accounts. Anecdotally, I know of several consumers whose accounts were stuck in limbo after trying to report a change to their.
Technical issues leave families in limbo
This Covered California limbo occurred with one of my clients. In February the married couple reported a change of income and the acquisition of employer group coverage for one of the household members. This couple, no longer eligible for the tax credit subsidy, wanted to keep an individual and family insurance plan in order to have access to their preferred hospital. After the reported changes, the system still showed both of the household member’s eligible for enrollment in a health plan. Unfortunately, the CalHEERS program would not let them select a new health plan. In addition, it only showed one member enrolled in the old plan but with a premium for two people. Even though the Covered California data was incorrect, at least their current individual and family health plan through Covered California was billing for just the one member.
We’ve escalated the problem to the Help Desk
In April I started calling Covered California about unlocking the system so the one member could enroll in a new health plan. Several Covered California service representatives tried unsuccessful to effectuate an enrollment in the correct health. Each time the service representative would escalate the issue to the Help Desk. By June my inquiries as to the state of their account was met with, “We’ve escalated it to the Help Desk with a priority flag.” I never heard from the Help Desk and neither did the family.
Covered California can’t solve enrollment problem
In August, with the Help Desk either incapable of solving the problem or just ignoring it, the Covered California service representative suggested withdrawing the application and starting all over. The thought of cancelling the plan retroactively and having to make back payments to a new plan that should have been effective April 1st, was too much for a couple who was having a baby in November. What if something went wrong and they were left without insurance?
Covered California erases health insurance enrollment
Something did go wrong; Covered California erased their enrollment information. In September I looked at their account and any reference to the one household member being enrolled in the health plan was erased. All the account displays is that the family participation ended as of February 28th. While no one at Covered California will acknowledge that the family member was enrolled in a health plan, this family continues to get and pay their health insurance invoices with the little Covered California logo on them.
Eligibility review triggers Special Enrollment Period
A review of the client’s Covered California reveals that the service center had been viewing and making changes to their account. It’s possible that whatever technical issue which had prevented the family from moving forward with their health insurance had been corrected. But no one at Covered California contacted them about any changes. And while the re-designed Summary section seems to provide less information than it did a year ago, the CalHEERS program is still could at cranking out nonsensical letters. Actually, it is one of these eligibility letters that shed some light on the overall erasure of the family’s health insurance status.
Eligibility update triggered health plan termination and erased the family’s current enrollment.
More confusing “Welcome to Covered California” letters
Whenever there is a change made to a Covered California account, before that change can be made permanent the entire application must be resubmitted for a redetermination of eligibility. Whenever the application is resubmitted and the eligibility re-determine, Covered California sends out a confusing welcome letter to the household. People have come to ignore these letters as a nuisance even though there may be some pertinent information included in the boilerplate letter.
Can know no one see the stupidity of the Covered California letter?
This is where the lethargy of bureaucracy enters the picture. A Covered California service representative conducted an eligibility review to this family’s account in mid-July. The resubmitted application terminated the family’s health insurance enrollment back to February 28th, 2015. The eligibility letter is dated July 18th. They are told their qualifying event on February 28th, gives them a Special Enrollment Period to choose a plan through April 29th, 2015.
This letter was sent out two and half months after the SEP ended!
Eligibility letter dated July 18th, informing family they have until April 29th, two months earlier, to select a health plan, that Covered California erased.
No enrollment changes at carrier
Whenever there are changes to Covered California account that will affect the consumer’s health insurance, that information is supposed to be sent to the carrier. The health insurance company has not received an update the health plan was terminated retroactively back to February. The household delegated me as their insurance agent back in March and that information has never been transmitted to the health plan. I’ve never been paid a commission on this family’s health insurance.
Family will now have to fight the IRS
I don’t deny that this family’s situation was perhaps unique and Covered California technical issues certainly played a role in attempting to correct the problems. But is one of those “life” situations that the CalHEERS Covered California program should be able to handle. I do believe the data is in the system some place but I can’t reach the correct person at Covered California to access it and explain the situation. The impending issue will be that Covered California won’t show that a member of this household had health insurance for the bulk of 2015 triggering the Shared Responsibility Payment (individual mandate fee) that must be paid on the families 2015 IRS tax return.
Audit Finds Accessibility Issues on Covered California Website
Although three of the four departments conducted some accessibility testing before the initial release of their web service, Franchise Tax Board is the only department that conducted regular update testing. Other departments we reviewed have not regularly tested subsequent updates to their websites. According to testing reports written by Covered California’s vendor, the vendor performed no dedicated accessibility testing after CalHEERS’ first major release to consumers in October 2013.13 The CalHEERS schedule shows that since that time, Covered California has issued updates to the CalHEERS website. Covered California’s chief of operational readiness confirmed that these updates included changes to content the public interacts with on the site but stated that most of the changes added functionality for Covered California staff. However, as we discussed in Chapter 1, Covered California recently updated a page on its website on which users begin an application for health insurance. That new page had a critical violation that blocked keyboard-only users from being able to begin an application. The assistant project manager for the CalHEERS project confirmed that Covered California was unaware of this accessibility violation until we brought it to its attention. More thorough testing of updates to the CalHEERS website would help Covered California guard against releasing inaccessible content. Table 7 on the previous page summarizes the initial and update testing performed by the four departments we reviewed. Pages 39 – 40-California State Government Websites, Report 2014-131. Published by California State Auditor, June 2015
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