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California Eligibility and Enrollment Report: Insurance Affordability Programs

California Department of Health Care Services and Covered California

A mandatory report to the California legislature provides an official reckoning of how many residents have gained health insurance and through which pathways.

California Assembly Bill X1-1 (AB X1-1) requires quarterly reporting on eligibility and enrollment processes for all California insurance affordability programs, including Medi-Cal, the Medi-Cal Access Program (formerly AIM), and qualified health plans available through Covered California. The law focuses on pathways and outcomes for new applicants, including application sites, consumer assistance, applicant demographics, resulting eligibility determinations, plan enrollment choices, and the volume and outcome of eligibility appeals.

Reporting on Pathways to Health Insurance Coverage: California's Experience

A February 2016 issue brief from Mathematica describes California's experience reporting on the eligibility and enrollment processes required by AB X1-1. It highlights some practical implications and offers lessons for other states. Read the full issue brief and listen to the podcast.


Here are highlights from the most recent California Department of Health Care Services (DHCS) and Covered California report, which covers the first quarter of 2015:

  • Total (net) Medi-Cal enrollment increased by approximately 240,000.
  • Approximately 910,000 individuals applied and were determined eligible for Medi-Cal; 340,000 applied and were determined eligible for enrollment in qualified health plans (QHPs) through Covered California.
  • 3.0 million cases were due for renewal of Medi-Cal, and 82% resulted in continued Medi-Cal coverage.
  • Over one-quarter (28%) of applicants reported that their primary spoken language was Spanish. About 45% of new Medi-Cal enrollees and 37% of those who selected a QHP and reported an ethnicity during this reporting period identified as Hispanic.
  • Seventy-one percent of applications determined eligible for Covered California QHPs were filed with assistance (similar to the previous reporting period).
  • Approximately 51% of all applications submitted through CalHEERS were initiated online (with and without assistance).

Work on the report was supported by Mathematica Policy Research through a CHCF grant.

The reports are available under External Links below.

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