Covered California update removes income assessment for unmarried pregnant women

Covered California will implement several changes to their online application program known at CalHEERS on August 1, 2016. One significant change is no longer assessing unmarried pregnant women’s income for determining Medi-Cal eligibility. The previous version automatically determined Medi-Cal eligibility based on a woman’s income and pregnancy status. Because Medi-Cal considers a pregnant woman a household two at a minimum, many women were tracked into Medi-Cal and not eligible for private health insurance with the subsidies.

Covered California changes to online application

The CalHEERS program build is 16.7 is slated to launch August 1^st. Other changes include member level plan selection, electronic verification of Medicare enrollment, remote identity proofing updates, non-health benefit services integration, and web browser log in restrictions.

CalHEERS Release Notes – 16.7 Certified Enrollers

CalHEERS Release 16.7 August 1, 2016

CalHEERS, also known as the online application, will be updated to version 16.7 on August 1, 2016. These release notes are intended to inform you of important changes to the functionality of the application.

16.7.1: Member Level Plan Selection for Advanced Premium Tax Credit (APTC) eligible households

APTC eligible consumers may select different plans for each member of the household or custom group members of the household into separate APTC eligible plans. The tax credits will be automatically disbursed across the selected individual plans or custom grouped plans.

• Previously, CalHEERS only allowed consumers to select one plan per tax filing household for APTC eligible applications and did not disburse tax credits among household members.
• This new feature allows consumers to choose a plan that may be best suited to their household member’s individual needs or network preference.
• This feature also assists consumers in our American Indian and Alaskan Native (AI/AN) populations who were previously unable to select AI/AN specific plans if some members of their household were not part of a federally recognized AI/AIN tribe.
• AI/AN members may be grouped together on an AI/AN specific plan while other members of the household can select individual plans or choose to be grouped together.
• AI/AN household members can also choose to be in the same non-AI/AN plan with non-AI/AN members. However, this will mean giving up certain Cost Sharing Reductions in the AI/AN plan that they would otherwise be eligible for.
• For more details on Member Level Benefits, review our Member Level Benefits Job Aid.

16.7.2: Electronic verification of Medicare enrollment from the Social Security Administration (SSA)

CalHEERS will utilize electronic verification from the SSA database to determine a consumer’s Medicare eligibility and enrollment status.

• Previously, CalHEERS would accept the consumer’s self-attestation regarding Medicare benefits received. There was no electronic verification.
• The results of this electronic verification check will be displayed on the eligibility results page. New language has been added to confirm a consumer’s “Eligible Status” or “Pending Eligibility Status” if an inconsistency is detected.
• For cases where manual verification is needed, “Proof of Medicare Coverage” has been added to the Document Category dropdown within the Upload Document popup.
  • Consumers can upload a Social Security Administration Letter, Medicare Letter, or Medicare Card to verify Medicare coverage.

16.7.3: Remote Identity Proofing (RIDP)

CalHEERS will feature text changes on the Remote Identity Proofing (RIDP) pages. Users will see changes in description text, as well as the drop down menus to improve clarity and readability of consumer messaging.

• Previously, consumers may have been confused on the function of the RIDP pages and what role they play in ensuring the security of their Personally Identifiable Information (PII).
• Additional options have been added to make the uploading of consumer ID documents a more streamlined process.
  • Users can now choose between two options for document types they may submit as proof of identification.

16.7.4: Integration of other Non-Health Benefit Services

Consumers with incomes less than or equal to 200% of the Federal Poverty Level will see new messaging and link options on the Additional Benefits Options Page in CalHEERS.

• Conditional text will populate stating “Based on the information you have provided it appears you may be eligible for additional assistance including food assistance. In order to determine your eligibility, you are encouraged to click on the Apply Now button.”
• The “Apply Now” button will navigate the user to a separate browser window to apply for these benefits.
• The user will additionally see a “Share My Information” button, which will send a referral to the local county Department of Social Services (DSS) rather than continue with a separate CalHEERS application.
  • If a referral has already been sent to CalFresh, CalWORKs or Medi-Cal, the Share My Information button is inactive.
• These new features are intended to streamline the process of a consumer’s DSS referral and get the consumer enrolled in the additional benefits their family may need in addition to their health benefits.

16.7.5: Income Assessment: Unmarried pregnant women, under 21 years old

CalHEERS will no longer assess income when determining eligibility for women who meet all the following conditions:

1. Pregnant
2. Unmarried
3. Under age 21
4. Living with her parent(s)
5. Non Tax Filer for the taxable year; or claimed as a tax dependent by parent(s) for the taxable year

• This population may be eligible for Medi-Cal benefits depending on FPL and immigration status
• Previously, the CalHEERS would assess the income of these individuals and make an eligibility determination based on their monthly income. This process may have led to Medi-Cal enrollment issues for the consumer.

16.7.6: CalHEERS web browser log in restrictions

Users will be restricted to one account login per web browser (i.e. Safari, Chrome, Internet Explorer). Users will not have the ability to open a new browser tab or browser window to log-in to their account and view multiple consumer applications.

• If a user attempts to log-in more than once in the same browser, a pop window will display the error message “We have detected that you are logged into your account in more than one window or tab. We cannot support more than one log-in session open at the same time. Please close one to continue.”