On Thursday, the Health Consumer Alliance alleged that Covered California has failed to promptly resolve customer service issues, sometimes resulting in blocked access to care or the inability for individuals to finalize their tax returns, the AP/Washington Times reports.
Details of Issues
According to HCA, the exchange has not quickly responded to enrollment-related mistakes within its computer system.
For example, the group said that Covered California staff has a limited ability to update the computer program used to determine consumers’ eligibility for exchange coverage or Medi-Cal, the state’s Medicaid program.
The group also alleged that Covered California has not corrected subsidy forms in a timely manner. As a result, some consumers have been unable to receive tax credits or amend their taxes, according to HCA.
In a letter to the exchange’s board members, HCA said, “We are concerned that public support for the (Affordable Care Act) will erode as more and more consumers encounter these types of tax problems and face exposure to IRS debts and penalties.”
Covered California Response
During a board meeting on Thursday, Covered California Executive Director Peter Lee said that the exchange is committed to resolving the issues quickly, noting that “a very small percentage” of consumers file appeals when rejected.
According to the AP/Times, Covered California since March has added staff to help resolve issues informally rather than through an administrative law process. However, Lee said the exchange “still ha[s] work to do.”
Lee noted that Covered California is working to fix information technology issues to allow staff members to make changes directly, rather than requiring them to file a help-desk request that can take several weeks to sort out.
Lee said that the “issue of having effective and as-prompt-as-possible resolution to appeals is something we take very seriously.”
Jen Flory — of the Western Center on Law Poverty, which is part of HCA — said she was pleased with Covered California’s goal of resolving tax form issues by September. However, she expressed concern about how long it has taken to make fixes to the California Healthcare Eligibility, Enrollment and Retention System.
She said, “We do want to work with staff to get some timelines to make sure these people [who] are waiting to get into plans actually have access to care” (Lin, AP/Washington Times, 8/20).