California enacted Senate Bill 260 in 2019 to help reduce the risk of coverage gaps when people transition from Medi-Cal (the state’s Medicaid program) to Covered California (its health insurance marketplace). The law instructs Covered California to automatically enroll eligible Californians transitioning off Medi-Cal in a subsidized marketplace plan, while allowing them to opt out or to choose a different plan. Launched in May 2023, the program facilitated the enrollment of about 112,000 Medi-Cal transitioners into marketplace coverage by March 2024.

This report examines the key policy and operational decisions California made to implement SB 260, the early results, and considerations for other states interested in establishing similar “facilitated enrollment” programs. Key findings include these:

• Although it is still early to assess the program fully, most informants interviewed believed that implementation had gone well. Many informants believe that, going forward, the priority should be to collect more information on transitioners’ experiences to inform improvements.
• States wanting to establish a similar program will need to:
  • Answer two critical policy questions: What will be the default marketplace health plan? Should peo­ple transitioning from Medicaid be enabled to opt in or opt out of that plan?
  • Conduct robust consumer education and outreach, informed by consumer testing and research, and col­lect, analyze, and publicly report data about the experiences of those transitioning and their coverage status.
  • Engage early and often with the health plans that will provide coverage to Medicaid transitioners.
  • Provide extensive and ongoing coordina­tion between a state’s Medicaid agency and its marketplace.