Exchange Reconsiders Agent Rules for Medi-Cal Enrollment Assistance

August 25, 2015

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Source: State of Reform

Covered California is considering changing the requirement that contracted brokers and insurance agents must assist individuals enrolling in Medi-Cal without compensation when they are eligible. At this week’s Board meeting, Covered California staff presented two options to the Board:

-Maintain the existing policy requiring certified agents to assist with Medi-Cal enrollment, regardless of compensation; or
-Encourage certified agents to assist, but also allow them to pass on individuals eligible for Medi-Cal to County Eligibility Workers.

Covered California’s per-application funding ended on June 30th of this year, which prompted the reconsideration of the policy. According to Executive Director Peter V. Lee, the current policy is intended to ensure there is “no wrong door” for individuals in need of Medi-Cal services.

While consumer advocates supported this concept, they raised concerns that brokers and agents are not typically well versed in Medi-Cal policies, which can lead to enrollees receiving inaccurate guidance. They requested that Covered California increase the number of trainings agents receive on Medi-Cal.

Julianne Broyles of the California Association of Health Underwriters (CAHU), expressed support in principle for the “no wrong door” policy, stating that referring individuals to county eligibility workers often hurts their ability to work with consumers once they reenter the commercial market.

“We want to help people…but there is a ‘moat’ between us and the county eligibility workers. Once we throw them over, we never see them again,” said Broyles.

However, Broyles added that without compensation CAHU would not be able to support the “no wrong door” policy.

Covered California staff will work with stakeholders and provide the Board with a recommendation at their October meeting. A stakeholder meeting has been scheduled for August 28th.

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