Issues concerning Medi-Cal eligibility and private health insurance enrollment have plagued the Covered California from day one. Part of the problems stem from the complicated of the several Medi-Cal programs, how they interact with CalHEERS, and the business rules engine that governs the conditions of eligibility for a Covered California plan.
Medi-Cal Renewals
A particular pinch point occurs with mixed households, or those families who have members eligible for both Medi-Cal and Covered California private health insurance. Specifically, there was a data and condition clash if the Medi-Cal eligible household member was in their annual renewal period. The clash would stymie Covered California household members from selecting a health plan.
CalHEERS Release Notes – 18.2
Medi-Cal Renewal Cases No Longer Prevent Covered California Enrollment
Previously, cases going through Medi-Cal Renewal for one member of the household prevented enrollment into a Covered California health plan for other members of the family. These cases required assistance from Covered California or counties to close the MAGI Medi-Cal renewal to complete enrollment. Cases were stuck when the county determines ineligibility or other negative action.
There were cases where the consumers were Covered California eligible, but they were unable to select a plan online. A Help Desk ticket was required to resolve many of these cases. This process was inefficient and consumers sometimes experience a gap in health care coverage.
Now, CalHEERS automatically closes Medi-Cal Renewal cases when all Medi-Cal members are found ineligible or discontinued. Consumers can change or select a plan so long as at least one member is eligible or conditionally eligible to a Covered California plan. Consumers that are eligible to Covered California will be able to select a plan without assistance from Covered California Service Center staff, the CalHEERS Help Desk staff, and county coordination.
Identity Verification Upgrade
Covered California must verify the identity of consumers applying for coverage and the Premium Tax Credits for eligibility. When a consumer is applying without any assistance, the consumer must use the Federal Data Services Hub. The Hub supplies four questions that the consumer must answer correctly before they can proceed with the application. There are scenarios when the Hub can’t supply the questions and the consumer cannot move forward.
The latest update to CalHEERS upgrades the Hub that will give more information to the consumer as to why the process cannot be completed.
CalHEERS Release Notes – 18.2
Identification Verification Upgraded
Previously, when verification of the primary contact identity is required, and the consumer could not provide documents to the Certified Enrollers, the application would automatically contact the Federal Data Services Hub to perform the remote identity proofing process.
Now the Federal Data Hub has been upgraded to include new security features and the posting of new and modified messaging when using this process. The messages provide specific response codes to those who fail the process and directions to call the vendor Experian to resolve any issues. There are many new scenarios with associated messages. Examples of messages are:
- HE000050 – RF3 – Use Limit Violation – User has attempted to remote identity proof 6 times within 16 hours through Hub and must wait allotted time before attempting identity proofing again
- HE200037 – SSN required to access consumer’s file, have consumer input SSN
Consumers who submitted an application prior to the implementation of the identity proofing functionality, must be identity proofed if they report a change to the primary contact page after the implementation of identity proofing.
If a consumer works with a Certified Enroller or health insurance agent, that person can upload a consumer’s photo ID to certify the identity.
Passwords
Perhaps the most difficult part of the Covered California application for the consumer is creating a password. The rules are very strict and have not always been adequately explained. Covered California has included more information to help consumers create a password when they have to reset it. The biggest complaint after the password has been rejected is that the system tells the consumer that the pass word cannot contain a dictionary word. You would be amazed at how many two letter combinations actually are words found in a dictionary. Hint: don’t put two letters together when creating a password. Always have letters separated by a number or special character.
CalHEERS Release Notes – 18.2
Password and Security Question Updates
Previously, some consumers experienced frustration with the password and security questions and were forced to call an enroller or the Service Center for assistance.
Now, CalHEERS has updated the password and security criteria so the rules are easier to understand and would make it less likely to have calls made to the Service Center or Certified Enrollers to assist with the account. This enhancement does not change any current passwords or force consumers to choose new ones.
Get Local Help
The Covered California Get Help feature will now display insurance agencies as well as individual agents.
CalHEERS Release Notes – 18.2
“Get Help” Now Lists Agencies
Previously, when consumers were looking for an Agent’s assistance, on their own or through the Service Center, the system provided a list of Agent names. Unfortunately, if the consumer did not know the name of the Agency, which they may have seen on a Storefront (Enrollment Center), they were unable to look that up the name of the Storefront. If the consumer noticed a Covered California logo on a business and remembered the name of the business, that information would not help them find their local agent.
Now, the “Get Help” experience has been improved to list both the Agent and Agency name in the contact information provided. When a consumer searches, as long as they know any part of the Agency name, the Agency will be listed. This new feature will help link a consumer to their local Agent and assist in the development of a closer relationship to the community.