Current Status in Establishing Exchange:
Established State Exchange.
Regular egislative process.
· The legislation creates the California Health Trust Fund within the State Treasury, so that the Exchange will be continuously appropriated and used to manage the finances. The same legislation also authorizes a loan of up to $5 million from the California Health Facilities Financing Authority to assist in establishment and operation of the Exchange. Both the California HealthCare Foundation and the Blue Shield California Foundation are also funded activities in preparation for applying for the federal Establishment grant.
· The California Health and Human Services Agency received a federal Exchange Planning grant of $1 million in September of 2010. On August 12, 2011 the state also received a federal Level One Establishment grant of $39.4 million, this will be used for overall business and operational planning, research and analysis, and implementation of an information technology system. In June of 2012 the state received a second Level One Establishment grant for $196.4 million for continued Exchange development.
· Small Group Plan
· EHB Benchmark Plan: Kaiser small group HMO plan
· Pediatric Dental Supplemental Plan: Healthy Families (CHIP) Plan
· Pediatric Vision Supplemental Plan: FEDVIP
· Former Governor Arnold Schwarzenegger (R) signed into law two complementary bills, AB 1602 and SB 900 on September 30, 2010, these bills establish the California Health Benefit Exchange.
· California was the first state in the nation to pass legislation creating a health insurance exchange after the enactment of federal health reform.
· The Exchange is governed by a five-member board, including: Secretary of California Health and Human Services (or designee) as a voting, ex officio member, two members appointed by the Governor, one member appointed by the Senate Committee on Rules, and one member appointed by the Speaker of Assembly. These members are not allowed to be affiliated in any way with a carrier or other insurer, an agent or broker, a health care provider, a health care facility or clinic, or trade association for these entities. Members must also not be health care providers, unless receiving no compensation for services provided.
· Current Board Members (The board hired an executive director who began in October 17, 2011):
o Diana S. Dooley (Chair), Secretary of California Health and Human Services
o Kimberly Belshé, Public Policy Institute of California
o Paul Fearer, Union Bank and Pacific Business Group on Health
o Susan Kennedy, former Chief of Staff for Governor Schwarzenegger
o Dr. Robert Ross, The California Endowment
· To mitigate the risk of adverse selection, the legislation requires carriers, whether they participate in the Exchange or not, offer a minimum of once choice at each of the four coverage levels. In addition, products that are offered within the Exchange (for individuals or small employers) are required to also be offered to that population outside of the Exchange.
· After stakeholder group session in February and March of 2012, in July the Exchange released a draft report with the help of subcontractors on qualified health plans (QHPs) options and recommendations based largely on stakeholder feedback.
· California’s complex linguistic and cultural diversity and size, the state had to begin soliciting broad stakeholder input for an Assister program. In June 2012, the subcontractors of the Exchange released there recommendations for Phase 1 and 2, the report recommended the fallowing:
o Asisters program include 2 distinct types of Assisters registered and certified by the Exchange
o Certified enrollment Assisters (Navigators) will be compensated by the Exchange and at minimum will include: non-profit ogranizations, community clinics, County Social Services offices, employing Eligibility Workers, and labor unions.
o Direct Benefit Assisters, are not to be paid by the Exchange and will include health insurance agents, hospitals, and providers.
o Certified Enrollment Assisters should be paid a compensation of $58 per successful Exchange application but given no compensation for renewals
o Training and certification guidelines for both types of Assisters have been developed.
· California has detailed enrollment goals that are broken down by potential enrollees’ insurance status and demographic characteristics.
· Continuing with Phase I between September and December 2012 the state plans to refine their media plan and begin to develop the training curriculum for the Assisters program.
· Phase II will begin between January and July 2013. During this time the state plans to begin educating consumers and to being paid media promoting the benefits of coverage.
· The Exchange is also exploring the options available for a service center and for branding the Exchange, but no final decisions have been made to date.
· California is participating in the “Enroll UX 2014” program, which is a pubic-private partnership creating design standards for exchanges that all states can use.
· In October 2011 legislation was signed that requires the creation of a single statewide application that will be available on paper and electronically for all systems and entitities accepting and processing applications and eligibility (Medi-Cal, Healthy Families, and the Exchange). This also requires a simplified citizenship and identity verification at application and renewal and increased coordination with other public programs.
· California has considered an optional bridge program available through the ACA, which allows states to use federal funding to offer subsidized health insurance to adults with incomes between 139 and 200% of the FPL who otherwise would be eligible to purchase subsidized coverage through and Exchange. They have yet to decide on this. Legislation was introduced in 2011 but the bill was held in Committee and effectively tabled in August of 2012.
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