July 28, 2015
To: All Covered California Certified Insurance Agents
Re: Medi-Cal Payments Ending
Since 2013, thousands of certified enrollment representatives have engaged in Covered California’s mission to help uninsured Californians enroll in the health insurance program that is right for them. This has resulted in reducing the uninsured rate in California by half from 22 percent to 11 percent. This tremendous reduction in the number of the uninsured included efforts to enroll individuals in both Covered California and Medi-Cal. It’s a significant effort that demonstrates the success of California in the transformation of health care in America to a system that increases access and affordability for all. With our third open enrollment approaching, Covered California is looking forward to working collaboratively with you to enroll and renew Californians in health insurance.
Early enrollment efforts, through the “no wrong door” approach, included compensation to both Certified Enrollment Entities and Certified Insurance Agents for enrolling consumers in both Covered California and Medi-Cal. All payments for Medi-Cal enrollments were funded by the Department of Health Care Services. Pursuant to the California State budget enacted for fiscal year 2015-2016, however, payments will no longer be made for enrollments in Medi-Cal submitted after June 30, 2015. Payments for qualified Medi-Cal enrollments prior to June 30 will continue to be issued for applications received by June 30, 2015 through that date.
Under Covered California’s contracts with all agents, which have been incorporated into regulations, agents must facilitate the enrollment of interested consumers into Medi-Cal. This requirement applies to Navigators and Certified Application Counselors as well. While payments for Medi-Cal have ended, the contractual requirement to facilitate enrollment in Medi-Cal still exists. As we go forward, Covered California is reviewing what level of assistance agents should provide.
Thank you for your continued commitment to enrolling Californians and for your partnership throughout the development of our program. We look forward to working together to make our third open enrollment a success.
Peter V. Lee
Download to original Notice to Agents Medi-Cal Payments Ending Letter.
Update on Medi-Cal payments