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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

June 2011 Archives

Question: I know California got a jump on the other states with exchange legislation and Massachusetts already had an exchange, but it seems most other states are dragging their feet. What's up?

Answer: Several additional states now have the laws in place to set up exchanges, including Maryland, Virginia, West Virginia, Indiana, Washington, Hawaii, Colorado, North Dakota, Oregon, and Vermont.

Here's the overall picture:

  • 5-10 states are moving forward, with speed and vision

  • 10-15 are actively "exploring" the legislative & policy terrain

  • 20-30 are still getting ready to get ready or actively resisting

Many states will not be able to get legislation passed in time to set up their own exchanges. In those chase the federal government will set up an exchange for them.

Question: I've heard there are some problems with subsidies for child-only coverage under ACA. Can you explain what these children and their families face, and what can be done to address these issues?

Answer: Employer-sponsored health insurance often does not cover dependents. In other instances, families find that the dependent coverage that is offered is unaffordable. Consequently, some children whose parents have group health coverage must rely on other sources of coverage, including Medi-Cal, CHIP or individual health insurance. Eligibility for premium subsidies under the ACA is limited for those without employer-sponsored health insurance, which may create challenges for parents wishing to purchase coverage for their children in the exchange. Clarification on how such subsidies will be determined is necessary.

Within-family variations in eligibility can complicate matters. Because of different income eligibility thresholds for adults vs. children, many children are eligible for
Medi-Cal or CHIP while their parents are not. Eligibility is also dependent on citizenship and documentation status, and variation in status among parents and children is not
uncommon. Citizen children of undocumented parents, for example, may be eligible for Medi-Cal while their parents are not. Under the ACA, some children will qualify for Medi-Cal or CHIP while their parents may qualify for premium subsidies to purchase coverage in the exchanges. Families in these situations may need special outreach to ensure they are aware of options for children, and integration of eligibility and enrollment processes for Medi-Cal, CHIP and exchange coverage will also be important.

Additional complexities are introduced when one parent is living outside the household, or when children live with grandparents, other relatives, guardians or in foster care. Today, parents living separately often share responsibility for obtaining their children's coverage, sometimes as a result of a court order, which can create many complexities. Issues also arise for children living in kinship care with neither parent - often
with grandparents who receive Medicare benefits, or with relatives who receive ESI, but for which the children do not qualify. Child support orders will need to evolve to
be consistent with new coverage requirements under the ACA, and options for child-only policies and associated subsidies will also require clarification.

Going forward, it will be important to consider how the law will apply to children living in these situations, and what special considerations for them may be warranted as the new regulations are developed and implemented. For more information, read the full report funded by the Robert Wood Johnson Foundation and prepared by researchers at the Urban Institute.

California got a $10 billion Medicaid Waiver. What does that mean?

The so-called "Medi-Cal waiver" is $10 billion in Medi-Cal funds that California secured from the federal government in November 2010.. Funds from the waiver go toward public hospitals and the expansion of local health programs.

According to Anthony Cava -- spokesperson for California's Department of Health Care Services - "the waiver could reduce state spending on health care by as much as $365 million annually".

Previously, seniors and people with disabilities who had Medi-Cal coverage could choose whether to find their own physician or enroll in a managed care plan if one was available in their area. Under the new policy, beneficiaries who live in counties that offer a managed care option will be required to sign up for that plan.

The 16 counties that will be affected by the change are:

  • Alameda
  • Contra Costa
  • Fresno
  • Kern
  • Kings
  • Los Angeles
  • Madera
  • Riverside
  • Sacramento
  • San Bernardino
  • San Diego
  • San Francisco
  • San Joaquin
  • Santa Clara
  • Stanislaus
  • Tulare

The shift to managed care will be phased in over the next year. Beneficiaries will need to select a plan by the month of their birthday, or the state will choose a plan for them.
Certain beneficiaries in the 16 counties will be exempt from the requirement, including:

  1. Children in foster care
  2. Those who pay part of their Medi-Cal costs
  3. Those who receive coverage from both Medi-Cal and Medicare
  4. Those who receive long-term care

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