Covered California Says It’s Moving Fast To Fix Involuntary Switches Into Medi-Cal

Under fire from federal lawmakers and consumer advocates, Covered California is speeding up its response to a systemic problem that is causing the transfer of some pregnant women from private insurance plans into Medi-Cal without notice or consent.
As first reported by California Healthline on April 18, at least 1,900 women with Covered California health plans who told the agency they were pregnant were automatically transferred to Medi-Cal, even though they were supposed to have the option to stay with Covered California.
As a result, some women lost their doctors or experienced delays in obtaining medical care.
Covered California attributed the problem partly to a computer glitch, and the agency’s communications director, Amy Palmer, has said it would be fixed in September.
Apparently that wasn’t fast enough for some members of the California U.S. congressional delegation. In an April 28 letter to Covered California and the head of the state’s Health and Human Services Agency, Congressman Ami Bera (D-Elk Grove) and 15 other members urged quick action.
“We remain concerned that until the problem is fixed in late 2016, women will continue to be unenrolled from their Covered California plans and lose access to their current medical providers,” they wrote.
Peter Lee, Covered California’s executive director, and Jennifer Kent, director of the state Department of Health Care Services, responded in a May 3 letter to the delegation, saying the problem will be further addressed by the end of May.
The letter was included in the public materials for Covered California’s monthly board meeting, which took place Thursday in Sacramento.
In the letter, Lee and Kent wrote that a system change “would make Covered California, not Medi-Cal, the default” for these women, while still giving them the option of enrolling in Medi-Cal as long as they were eligible. Only women in certain income brackets are affected by the glitch.
“This change is now set to roll out later this month,” they said.
The extent of the system change, however, is unclear. Covered California spokeswoman Lizelda Lopez told California Healthline Thursday that “our plan at this time is to directly contact any enrollee with [qualifying income] when they report a pregnancy to ensure they are enrolled in the insurance they prefer.”
She did not say how the women will be contacted.
Asked whether the fix includes an expedited repair of the computer system that has been set for September, she said, “I have no further details at this time and won’t have them today. Not sure when I will.”
The letter from Lee and Kent identified other steps that Covered California has taken to limit the number of women who are switched to Medi-Cal without their consent, including a warning to consumers on its website and specific training for customer service reps.
The website warning informs consumers that reporting their pregnancy to Covered California “is not necessary or recommended” unless they’re interested in other coverage options, such as Medi-Cal.
“I appreciate Covered California taking this issue seriously … Prenatal care is essential for the health of both mother and child, and no one should be forced to hide their pregnancy,” Bera, a doctor, said via email.