Some agents were developing a marketing strategy that capitalized on the difference in commissions between agents and assisters. With assister enrollment payments fixed at $58 and the agent commission expected to be somewhat higher, the deal involved agents paying assister entities more than $58 for the referral. Similar arrangements between agents and grantees would be more lucrative for both sides of the deal because grantees have received a lump sum an are not paid by enrollment.

Because of the concern that financial arrangements between agents and grantees, Assisters or community-based organizations would increase the overall cost of marketing and enrollment assistance, which are directly reflected in health plans’ costs, Covered California is making a policy clarification, with the following recommendations:

Covered California encourages non-monetary partnerships among all groups offering enrollment assistance. With regard to financial arrangements that could increase overall marketing and enrollment costs, staff recommend adoption of the following recommendations:

1. Prohibit grantees and Assisters from accepting payment or other valuable consideration from agents for referrals and/or enrollment services; and
2. Prohibit agents trained and certified by Covered California from providing payment or other valuable consideration to grantees, Assisters and other community-based groups for referrals and/or enrollment services as a condition of program participation.