Exchange Ramps Up as Deadline Nears

by David Gorn, California Healthline Sacramento Bureau

TOPIC ALERT:

It's a little like putting on Thanksgiving dinner ... on a really large scale.

There are dozens of dishes, each one complex and difficult. Some dishes take less time, some take more, some are bigger and some are smaller -- but they all have to hit the table hot at the same time.

For Covered California, Thanksgiving comes a bit early -- Oct. 1.

"It's busy here right now. There are a lot of elements in pulling all of this together," said Larry Hicks, information officer at Covered California.

There's the rollout of the media campaign, the community outreach effort, the health care provider outreach, finalizing details with health plans, coordinating insurance agents, creating call centers, coordinating with federal officials, working with the state and counties on a Medi-Cal expansion interface, establishing a small-business program, and launching an online eligibility determination and enrollment system.

That's a pretty full plate.

"We're coming at this hard. We're coming at this with a focus so that it will all come down to a single point -- to enroll millions of Californians [in] affordable health care," Hicks said.

Oct. 1 -- Prelude to Jan. 1

Insurance coverage begins Jan. 1, 2014, at the Covered California exchange, but the effort to sign people up for that coverage launches three months before that, on Oct. 1.

The October date is when enrollment opens. That means everything has to be in place by that date -- agents and call centers will be open for business, and the state will unveil its online system to determine eligibility for the exchange and for Medi-Cal. The system will allow people to enroll in coverage in October, though the coverage itself won't take effect until January.

An estimated 5.3 million Californians will be eligible to purchase health insurance through the exchange and about half of them -- 2.6 million -- will be eligible for premium assistance to help pay for it, according to exchange officials. Another one million Californians will be newly eligible for Medi-Cal under the expansion, also starting in 2014, according to estimates. The state's online enrollment system is designed to help people determine eligibility and enroll in one of those programs.

"The important date is Jan. 1, that's what everyone focuses on, when everything starts," Covered California Executive Director Peter Lee said at a recent board meeting. "But for us, our real window is up until Dec 15." That's the last day Californians can enroll and still be covered come Jan. 1. Moving backward from there, the date on which everyone at the exchange is currently focused is Oct. 1.

"We will be live and serving consumers Oct. 1," Lee said. "That's a big day."

According to Karen Ruiz, project director for the CalHEERS computer system that will facilitate enrollment in the exchange, the system will be functioning on time.

"We are on track to be ready Oct. 1," she said.

So Many Projects, So Little Time

The Covered California media campaign launching this week will come out in stages, according to Hicks. It will be ongoing throughout the October-to-January enrollment period and likely will extend beyond that.

"You'll see a lot of it at the end of September and the start of October," Hicks said. "California is a diverse state, and you'll see that diversity represented [in the media campaign]."

The media blitz is a major piece of the exchange outreach effort, but it is not the only piece. The other major components include:

  • Community outreach: The outreach effort includes about 3,200 community-based organizations and their workers, who will help sign people up for the exchange, Hicks said. "That means nonprofits, medical clinics, chambers of commerce, school districts, pillars of the community that will serve as our storefronts," Hicks said, "and provide consumers with one-on-one help to find coverage."
  • Insurance agent training: Thousands of insurance agents will get instruction on exchange policies, be certified and ready to sell starting Oct. 1, Hicks said.
  • Call centers: Call centers already are operational in Concord (Contra Costa County) and Rancho Cordova (Sacramento County), with hundreds of people receiving training to handle calls. A lease has been signed and hiring is underway to staff the Fresno call center site in time for October.
  • Bridge proposal: Covered California officials are seeking federal approval of a plan to manage Medi-Cal beneficiaries in the new exchange -- to build a bridge between Medi-Cal and private coverage.
  • SHOP exchange: A plan for a Small Business Health Options Program -- "SHOP exchange" -- has been established. The exchange finished its design review with CMS and completed a three-day Internal Revenue Service audit.
  • Provider outreach: Exchange officials started a provider outreach program with recent grant awards of about $3 million to medical associations, aimed at educating physicians and other health care providers about the exchange options. 
  • Coordination with Medi-Cal expansion: "With the expansion of Medi-Cal, there will be thousands of county workers who will assist people and see if they qualify for Medi-Cal," Hicks said. Some of those Californians may be referred to coverage in the exchange.

"People can get assistance by phone, online and in-person in their community," Hicks said. "There is some complexity on our end, but part of our goal and mission to make enrolling as simple as possible."

The exchange is doing everything it can to bring all of those pieces together in an accessible manner, Hicks said.

"There is certainly complexity on the back end," he said. "And hopefully that will not be seen on the front end, at all."

All the behind-the-scenes work setting up the exchange is now coming down to its final month of preparation, its final run-up to ringing the big dinner bell.

"So yes, things are ramping up here," Hicks said. "It's busy. Primary among our goals is we need to keep the public involved and informed. There are a lot of elements in pulling all of this together."


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