Lessons from California:
The Streamlined Application
To date Covered California
, the state based exchange, has enrolled more than ½ million individuals
in both the private insurance marketplace and its Medicaid program (Medi-Cal). California’s on-line application portal
(called “CalHEERS”) went live on October 1, 2013 without major technology issues. A successful feature allowed consumers to review the available plans and covered benefits without creating an on-line account. Yet the on-line system interface with Medi-Cal’s eligibility IT system was delayed until mid-January and led to the need for an application file transfer process between Covered California and Medi-Cal, similar to that between the states with federally-facilitated marketplaces.
STRATEGY AND ACTIONS:
California’s consumer friendly on-line and paper applications are a result of a transparent stakeholder process, required by legislation
, which provided advocates the opportunity to comment on multiple versions
of the paper and on-line applications, to ensure compliance with federal and existing state regulations, and to raise concerns
or identify potential barriers to enrollment. For example, based on NHeLP’s recommendations
, California is carefully implementing the identity proofing required by the federal government
to minimize its potential barrier to enrollment and will use proof of identity to satisfy the state residency requirement.
Modifications continue to be made to CalHEERS to add new rules or fix processing errors or glitches. As enrollment continues in all states, there is an on-going need for stakeholder input and system accountability. Advocates should have access to a test site or dummy account ID for the application portal to allow them to better assist clients and troubleshoot in real-time. Advocates should also be able to review the operational business rules that are not currently accessible to consumer stakeholders. This would allow advocates to identify existing problems from a consumer’s perspective and help minimize application barriers in the system before the next open enrollment period begins.
Streamlined application requirements:
45 CFR §§155.310, 155.405;
42 CFR § 435.907