No Wrong Door, Many Paths

The Affordable Care Act (ACA) promises to make health insurance more accessible and more affordable. Bringing people in through an effective enrollment process is the first step in keeping those promises. Like some other states and the federal government, California built an online portal to its marketplace as part of its effort to modernize an inherently complex enrollment process. As the state gears up for the 2015 enrollment cycle, the California Health Care Foundation (CHCF) has published an interactive guide to that online process that explains the information required of consumers and the way the system works behind the scenes.

This year health insurance enrollment became an opportunity — and a requirement — for millions of Californians through the ACA. Nearly 1.4 million people signed up for private insurance through Covered California in its first open-enrollment period, and an estimated 2 million have joined the Medi-Cal rolls as a result of expanded eligibility for that program. It’s a major success, and worth celebrating.

The ACA wrote into law the concept of a no-wrong-door approach to coverage for eligible applicants — the idea that regardless of program eligibility, income, location, or method of application, consumers would experience a seamless system that could help them wherever and whenever they entered. We’ve come far toward delivering on this promise, but we still have a long way to go.

California still has a backlog of 350,000 Medi-Cal applicants — down from nearly one million earlier this year. Some had to wait more than six months to learn if they would receive benefits. With open enrollment for 2015 beginning on November 15, Covered California renewals are an important area of focus. In order to solidify the state’s insurance gains, we need to ensure that people’s coverage is uninterrupted, whether they stay in one program or move between Covered California and Medi-Cal. While automatic renewal in existing plans is an important backstop to keep people enrolled, we also need to ensure that people understand their options and the financial implications of their choices. And the people who are eligible, but have not yet enrolled in coverage, will require more effective and potentially more costly outreach and assistance efforts.

CHCF’s interest in improving enrollment processes goes back to our earliest days. In the late 1990s, it became clear that hundreds of thousands of eligible people were not enrolling in public programs, and we determined that a highly effective way to reduce that number was to simplify the application process. Since then, CHCF has been committed to understanding and addressing barriers to enrollment and has invested in people, processes, and technology to make this happen.

Our latest effort is an infographic called “Pathway to Enrollment.” It’s designed to help policymakers, journalists, and the public understand how online enrollment works in California by providing an overview of the process that families encounter when they apply for insurance through the Covered California portal. The infographic highlights the information consumers are asked to provide and the decisions they have to make as they follow the application steps. It also aims to shed light on the behind-the-scenes workings of the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) — the eligibility engine developed by Covered California and the California Department of Health Care Services (DHCS) — and how that system interacts with federal data verification systems.

The ACA simplified Medi-Cal eligibility by aligning Medi-Cal and Covered California income standards and moving the state toward a more coordinated approach. By highlighting the different paths of three fictional families, however, this infographic illustrates how variable the application process can be, and how enrollment is not, in fact, seamless. Eligibility factors such as income, family structure, and immigration status make a big difference in families’ experiences as they apply for coverage, and may send members of the same family along wholly different paths. In California, such families are not uncommon. The real-world experiences of families like these need to remain front and center as the state continues to invest in people, processes, and technology that deliver efficient, timely, and straightforward — if not always simple — solutions.