Covered California announced in mid-July they were awarding $10 million in grants to a Navigator program that performed poorly in 2015. Two weeks later Covered California sent out a letter to agents that they would no longer be compensated for assisting individuals and families who are determined eligible for Medi-Cal. For the 2015 open enrollment period Certified Insurance Agents assisted with 43% of new enrollments, while the Navigators assisted with only 10% of enrollments according to Covered California.
Navigators failed to meet 2015 goals
The Navigator Program is mandated by the Affordable Care Act. In October 2014 Covered California awarded $14.65 million to 65 organizations throughout California to be Navigators for the 2015 open enrollment period. Navigators were supposed to enroll 92,817 individuals in Covered California health plans that were eligible for tax credits. Medi-Cal enrollments did not count toward meet the Navigators goal. At the January 2015 Board meeting, Acting Deputy Director, Sales Division, outlined what a difficult time the Navigators were having meeting their enrollment goals.
Navigator numbers are sketchy
Navigators were complaining that most of their enrollments were for Medi-Cal and not premium tax credit eligible private plans. As of March 5th, 2015, Certified Enrollment Counselors and Navigators had only enrolled 51,040 in Qualified Health Plans with tax credits through Covered California. There has been no subsequent update that I could locate that indicated the Navigators met their enrollment goals before the expiration of the contracts. Covered California only cares about private plan enrollment because the health plans pay them a monthly fee per person enrolled. Covered California receives no compensation for Medi-Cal enrollments. [How much does Covered California earn from each enrollment?]
Nominal agent compensation for Medi-Cal enrollments
In 2014 Covered California was able to cobble together a federal grant along with authorizing state legislation to pay Certified Insurance Agents $58 per Medi-Cal enrollment. These had to be new enrollments into Medi-Cal. Mixed households where the children were Medi-Cal and the parents were eligible for tax credits did not qualify for the $58 compensation. While a number of agents have documented they never received any compensation for their Medi-Cal enrollments, Covered California reported at their June Board meeting that approximately 4,700 agents had been paid $5.9 million in Medi-Cal payments for enrollments since January 2014.
Covered California cuts Medi-Cal compensation to agents
Covered California cuts Medi-Cal compensation to agents
Covered California sent out an email in the last week of July notifying agents that Medi-Cal enrollments after June 30, 2015 will no longer be compensated. It is not mandated that Covered California pay agents for Medi-Cal enrollments. However, it explicitly states in the agreement between Covered California and each Certified Insurance Agent that he or she must help facilitate the enrollment into Medi-Cal if that is what the individual or family qualify for.
Navigators wiggle out of contract obligations
At the March 5, 2015 Board meeting, Covered California staff recommended that Navigators who did not meet their enrollment goals not be required to reimburse the exchange for grant money they received. The proposal at the March Board meeting suggests that the new Navigator program is a glorified outreach and marketing program:
Initial recommendations for 2015/16:
- Block grant compensation model with a small portion of funding based on performance.
- Focus on target communities with a high number of remaining uninsured to provide outreach & education, enrollment assistance, renewal and post enrollment support.
- Priority given to organizations that have demonstrated their ability to enroll QHP eligible consumers.
Navigator funding targeting at regions with high Medi-Cal populations
When you look at the organizations who are receiving the Navigator grants and the communities they are serving, it’s obvious that the Navigator program is focused on enrolling Medi-Cal eligible individuals. And there is nothing wrong with that concept. Essentially, Covered California is allocating $10 million for Navigators to enroll people into Medi-Cal when only $6 million was spent compensating Certified Insurance Agents for Medi-Cal enrollments over an eighteen month period with possibly more people actually entered into the Medi-Cal program.
How did the 2015 Navigators perform?
Covered California has never released the figures on how many individuals the 2014-15 Navigators enrolled in Medi-Cal or Qualified Health Plans for the tax credits. We have not been told how far short the Navigators fell in meeting their enrollments based on signed contracts with Covered California. We’ve never been told what the Navigators actually spent their grant awards on. There has been a decided lack of transparency with the Navigator program.
Agents enrolled 43% of new Covered California individuals
But we know that agents enrolled 43% QHP individuals for 2015. We know that agents received $5.9 million for Medi-Cal enrollments which translates into approximately 101,724 individuals ($5.9 million divided by $58 per individual). We know that the agent Medi-Cal enrollment is actually higher because children in mixed households are not counted for the $58 compensation. Based on these estimates, agents enrolled twice as many people in Medi-Cal than the Navigator enrolled in private health insurance plans for 2015.
Covered California shouldn’t be funding Medi-Cal outreach
The purpose of Covered California is to enroll eligible individuals into health plans on the exchange that qualify for the ACA Premium Tax Credits. It’s wonderful that Covered California has attempted to be a “No Wrong Door” organization with respect to accessing health insurance. But Medi-Cal is handled by the Department of Managed Health Care and the Department of Health Care Services. Those two agencies should be funding enrollment services into Medi-Cal health plans, not Covered California.
Enrollment is the same for Medi-Cal or QHP
As a Certified Insurance Agent I won’t discriminate based on whether an individual or family is eligible for Medi-Cal or tax credits for a private health plan through Covered California. It takes just as much time to enroll someone in Medi-Cal as it does the private health plans but I will no longer be compensated for my services of assisting a Medi-Cal eligible individual. Organizations that received Navigator grants will be indirectly be compensated for Medi-Cal enrollments.
Public Records Request Act
In an effort to get more information about how the Navigator program was managed and ultimately performed, I have file a Public Records Request from Covered California about the 2014 – 2015 grant award period. You can view my Public Records Request at this link -> Public Records Request of Covered California, August, 2015