Covered CA Glitch Diverting Some to Medi-Cal

With a key deadline arriving today, the state’s health insurance exchange has continued to increase enrollment even as computer glitches divert some who seek to enroll or renew existing policies.

Californians have until midnight today to enroll and have their policies start on Jan. 1. While open enrollment lasts until Feb. 15, policies purchased after today will not start on New Year’s Day.

As the deadline arrives, Covered California is investigating a computer problem that has diverted some applicants to Medi-Cal coverage even though they qualify to purchase a policy from commercial insurance companies that sell on the exchange. The two programs have differences such as the availability of doctors in various networks.

Amy Palmer, communications director for Covered California, said Friday that a group at the exchange is trying to sort out the situation.

“We are aware that this is happening, and we’ve been working to remedy the situation for consumers,” Palmer said.

Palmer said people who have been mistakenly categorized in Medi-Cal shouldn’t worry if the situation hasn’t been resolved by the end of Monday. She said the exchange will work to make sure their policies are readjusted and become effective on the first day of the new year.

The executive had no estimate of how many consumers were affected by the glitch.

Insurance experts said dealing with the computer malfunction has been vexing.

Craig Gussin, a local health insurance broker, said he has several clients who were thrown into Medi-Cal status when they attempted to modify their income levels on the exchange’s website. He said it has taken hours on the phone with the exchange to explain the income issue and get it resolved.

“It’s really a mess. It’s why I’m going to be spending my whole weekend looking at every person’s file to make sure that it’s as accurate as we can make it,” Gussin said.

Mike McCaffrey, an agent in Woodland Hills and past president of the National Association of Insurance and Financial Advisors — California, said he also has run into the Medi-Cal diversion problem as recently as Thursday.

He described a situation in which a family had to modify its estimated income level and remove one of several listed dependents.

“When we got done with the application, essentially this family’s two youngest children were defaulted into Medi-Cal,” he said.

After reporting the problem to the exchange, McCaffrey said he was given a 10-day time frame for a correction.

Others have reported delays in using Covered California’s website.

John West of San Diego said he has struggled to change an existing Covered California plan with Anthem Blue Cross to Sharp Health Plan.

“We had problems with some of the links on the site not working. We’ve probably spent 20 or 30 hours and I still don’t have a policy yet,” West said last week.

Palmer, the Covered California spokeswoman, said overall, the enrollment experience has gone more smoothly this year than it did last year, when more than 1 million applicants to the exchange and an additional 2 million who signed up for Medi-Cal clogged the system.

She said as of Dec. 3, the exchange had enrolled more people in the first 19 days of its second open-enrollment period than it did in the first 30 days of operation last year.

“We certainly know the system is not perfect, but we think it’s better than it was last year,” Palmer said. “Our enrollment numbers indicate it is working for many thousands of people.”

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