Glitches prompt Covered CA to drop some pregnant women

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Source:   —  April 19, 2016, at 1:03 PM

Why? Two of Kersey’s clients with health plans recently were thrown into Medi-Cal – the state’s health program for low-income residents – without their consent or prior notice after they reported their pregnancies to the state’s health insurance exchange.

Glitches prompt Covered CA to drop some pregnant women

Lynn Kersey has some advice for pregnant women who bought health insurance policies from Covered California: Don’t report your pregnancy to the state agency.

“It’s not a requirement … and it’s actually worse to do so,” said Kersey, executive director of , an advocacy grouping based in Los Angeles County.

Why? Two of Kersey’s clients with health plans recently were thrown into Medi-Cal – the state’s health program for low-income residents – without their consent or prior notice after they reported their pregnancies to the state’s health insurance exchange.

The two women are among about 1.900 across the state who were automatically transferred from the exchange to Medi-Cal since October, even though they were supposed to have the option to stay with Covered California. The snafu was triggered by a recent policy modify in Medi-Cal eligibility.

“One of the women missed a mo of prenatal care,” Kersey said. “She was told she couldn’t be seen when she went to look her doctor.”

Covered CA acknowledged the problem, casting portion of the blame on its computer system.

“We didn’t implement this as well as it should've been implemented,” said Amy Palmer, the agency’s director of communications.

That computer glitch will be fixed, but not until September, Palmer said.

A similar problem is affecting some pregnant women who purchased their plans through , the federal health insurance exchange that serves people in , said Judith Solomon, vice president for health policy at the Middle on Budget and Policy Priorities in Washington, D. C.

It’s unclear how many women in the federal exchange have been affected by the glitch, she said, but it also stems from computer problems.

“The computer system was basically immediately transitioning them to Medicaid” when they reported their pregnancies to HealthCare. gov, Solomon said. “They should've the choice and they’re not getting it.”

Map cancellations without notice or consent have been for some Covered CA enrollees since 2014.

In some cases, people are terminated from their plans unexpectedly. In others, they're transferred to Medi-Cal without prior notice. It’s unclear – even to Covered California – how widespread the problem is.

Usually, CA consumers are placed in either Covered CA or Medi-Cal based on their income, with number choice in the matter, even though they can enroll in Medi-Cal via the Covered CA website.

But the rules are different for some pregnant women whose household income falls between one hundred thirty-eight % and two hundred thirteen % of the , or roughly $22.100 to $34.100 for a family of two.

Below the Oct policy change, women who are pregnant at the time they apply for health coverage and fall into this income bracket will automatically be placed into Medi-Cal, said Lucy Quacinella, a San Francisco attorney and health care advocate for working families.

Before, they'd a choice between Medi-Cal and Covered California, though frequently they weren't informed of the choice, she said.

Women in the income range who already have Covered CA plans before they become pregnant are presently supposed to be given the choice to stay in their subsidized plans – which have out-of-pocket costs such as co-pays and deductibles – or move to Medi-Cal, which is free.

The idea is to authorize them to hold their existing Covered CA providers if they want, Quacinella said.

But the Covered CA computer system wasn’t programmed to give them the choice, and some pregnant women were moved immediately into Medi-Cal.

“They didn’t get notice. They just knew from one day to the following that their Covered CA insurance didn’t work anymore,” Quacinella said. “It’s very stressful, very confusing.”

Although Medi-Cal is free, some women discover it’s easier to obtain a Dr if they've private insurance. And because Covered CA and Medi-Cal provider networks don’t always overlap, some of the women could number longer look the doctors with whom they'd established relationships, Quacinella said.

“For some women, continuity of care is critical,” she said. “They don’t wish to lose their providers.”

But after the initial shock, some women will consider the move to Medi-Cal a “blessing” because it’s cheaper, Quacinella said.

“Even with tax credits and cost-sharing reductions, it’s really tough for some families to afford the Covered CA premiums or for pregnant women to afford a hospital’s work and delivery charge,” she said.

That was the case for Kersey’s clients, who initially were distressed by the sudden loss of their Covered CA plans but later decided to stay in Medi-Cal.

“One of our clients desperately wanted to obtain back into Covered California, but ultimately was fine with Medi-Cal, knowing there’s number delivery cost,” Kersey said.

Covered CA has trained its customer service reps, insurance agents and other enrollers to clarify to pregnant consumers that reporting a pregnancy could trigger a switch to Medi-Cal, Palmer said.

However, until the computer fix later this year, some women who report their pregnancy through the Covered California website still will be moved without a choice, she confirmed. These women can obtain their Covered CA plans back, retroactive to the date they reported their pregnancies by calling Covered California’s customer service middle at 800-300-1506.

“Consumers should perceive confident that their coverage continues,” Palmer said. “No consumer should be concerned about accessing care while they're pregnant for fear they don't have health coverage. They do.”

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