CalOptima Health, the insurer of Orange County’s lowest-income residents, could join Covered California, the state’s Affordable Care Act marketplace, to expand its reach.
By launching a Covered California plan, CalOptima members who are no longer eligible for Medi-Cal coverage due to income changes, could keep their health provider and avoid a gap in care, CalOptima Chief of Staff Veronica Carpenter said.
The OC Board of Supervisors agreed on Dec. 3 to make the changes that would make it possible for CalOptima to participate in Covered California.
“CalOptima Health’s ordinance change to join Covered California will provide much-needed coverage for people who lose Medi-Cal due to fluctuating income,” Second District Supervisor Vicente Sarmiento said.
The board will have to vote a second time on the proposed change, which is expected to happen at its next meeting on Dec. 17. CalOptima Health will also need to obtain approval from both Covered California and the California Department of Managed Health Care.
Allowing CalOptima Health to enter into Covered California would bridge the coverage gap and keep family members in aligned networks at affordable premiums, Fifth District Supervisor Katrina Foley said in a statement.
“A Covered California plan will also support safety net providers by offering a new line of business and a way to maintain relationships and continuity of care with patients transitioning out of Medi-Cal,” Foley added.
Pointing to the latest Community Indicators Report commissioned by the Orange County Business Council, Carpenter said 6.3% of the county’s population remains uninsured, emphasizing the need for affordable healthcare options.
“In terms of the expanded targeted reach, it’s also veterans who do not qualify for Medi-Cal benefits or may have a gap in coverage, mixed households that lose coverage and want to remain in the same network,” Carpenter said. “The ones who are inadvertently disqualified from Medi-Cal due to maybe some small increase in compensation, and then individuals and families who don’t have employee-sponsored healthcare.”
As CalOptima starts the process to join Covered California, CEO Michael Hunn said it’s important that Medi-Cal members know when they need to redetermine their eligibility, a process that was brought back by the state last year after being paused during the pandemic.
“(They need) to make sure that they properly fill out their redetermine application and file it back with the state through our Orange County Social Services Agency,” Hunn said. “And then finally, if they know that their income has gone above the qualifying level, before they lose their medical coverage and so they don’t have a gap, they should go to Covered California and look for a plan that they can sign up for.”
Also by joining Covered California, which could happen by 2027 if all the necessary approvals are received, Carpenter said CalOptima will have the ability to help members navigate the switch when their circumstances change.
“It could be as easy as a flip of a switch. You made $200 extra this month. Let’s flip around to Covered California and automate that process,” Carpenter said. “Access to healthcare is everything, so if we can make that component of their lives just a little bit easier, then we’ve achieved what we’ve set out to do.”
Members can find more information at CalOptima.org/en/CoveredCalifornia.
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