Some Californians who purchased individual health coverage through the state’s insurance exchange are suddenly being dropped or transferred to Medi-Cal, the state Medicaid program for the poor that fewer doctors and providers accept.
Covered California, which is responsible for determining and directing Californians to an appropriate health plan, has no estimate of how many people are affected, saying only that the changes are occurring as incomes are checked to verify the policyholders can purchase insurance through the exchange.
Since the shifts often happen without warning, there’s confusion and anger among policyholders.
Glendale resident Andrea Beckum learned last month that she and her husband had been shunted to Medi-Cal only after getting a call from their insurance broker telling them their Anthem Blue Cross policy had been canceled. It’s a mystery because they make above the $21,707 threshold for two people to qualify for Medi-Cal, she said.
When the couple met with Los Angeles County social service workers, they were told they make too much to qualify for Medi-Cal. Now they are uninsured and considering an appeal.
“That’s the crazy part,” said Beckum, 35, a part-time neuropsychology researcher. “Even if we were in Medi-Cal, we don’t qualify for Medi-Cal.”
Covered California launched the online marketplace in October 2013 as part of the state’s implementation of the federal Affordable Care Act. The exchange offers sliding-scale subsidies for private coverage to lower-income and middle-class people with no access to health care on the job, and directs the poor to county social service offices for Medi-Cal.
Assemblyman Richard Pan, D-Sacramento, who chairs the Assembly Health Committee, said he will hold a hearing on Sept. 23 and look, among other things, at why people are losing coverage and what can be done to reduce interruptions.
“Implementing the Affordable Care Act, clearly it’s not something that just stops at the end of open enrollment,” Pan said. “There are ongoing issues.”
Officials at Covered California acknowledged that a number of people are being shifted around during income checks and eligibility updates.
“It will happen continually,” spokesman Dana Howard said.
This year, he said, the exchange adjusted its income eligibility scale when the federal government updated the poverty scale. As a result, Howard said, people near the thresholds are sometimes moved between private health plans and Medi-Cal. The checks might also determine that some people make too much money to receive a subsidy.
Covered California said the goal is to make sure that the 1.2 million people who were determined to be eligible for a subsidy receive the appropriate amount. Overall, 1.4 million people are enrolled with a health plan through the exchange.
The exchange could not provide an estimate of how much in subsidies Californians have qualified for this year.
Officials say they are researching the Beckums’ case.
“I don’t have the complete picture yet to share,” said Larry Hicks, another spokesman.
During the past few weeks, Beckum has been on a frustration-filled journey marked by long trips to the welfare office and extended telephone calls with Covered California. She believes the cancellation of their coverage stems from a mistake by a Covered California service representative who entered the wrong income, and she has been unable to get the exchange to resolve her case.
“It’s one of the worst things I’ve ever dealt with,” she said. “It’s total incompetence”
The Beckums are now stuck with a $519 bill for a mammogram she had after they lost coverage.
Evette Tsang, a Sacramento insurance agent, said some of her clients unexpectedly received Medi-Cal cards even though they were content with the plan they purchased through the exchange.
“There’s a lot of people who have never been on Medi-Cal, and they don’t want to. You hear the service is not as good, providers are not easy to find,” Tsang said.
Tsang said she has had mixed results trying to fix her clients’ problems. She was able to help one small business owner keep her health plan after Covered California entered her roughly $42,000 household income as $70,000. Another client became pregnant and was shifted to Medi-Cal.
“I told her, ‘I cannot help you,'” said Tsang, who initially raised concerns to Emily Bazar, a senior writer at the California HealthCare Foundation’s Center for Health Reporting.
Covered California’s Facebook page is filled with people expressing anger about policy cancellations, unfixed errors and poor customer service.
“I know that Covered California is working on that but we need … to be sure that people don’t have interruption in their coverage,” said Pan.