policy

We write today related to the proposed regulation in 155.225(g)(2), relating to compensation or consideration for certified application counselors from any health issuer for enrolling individuals into Qualified or nonQualified Health Plans. The current language appears to be directed towards agents and brokers, but in its current form, could have unintended negative consequences on California’s public Medi-Cal managed care plans that have long had an important enrollment function. As currently drafted, this could bar enrollment staff employed by public Medi-Cal managed care plans that are non-QHPs from serving as Certified Application Counselors and our plans from serving as Certified Application Counselor organizations.

California’s public Medi-Cal managed care plans have been attempting to provide enrollment assistance services to Covered CA for over a year. We have no desire for any compensation from Covered CA for providing this service. Medi-Cal plans in California have successfully partnered with the State and counties to provide enrollment services for CHIP and local uninsured coverage programs for many years – in San Francisco, the public Medi-Cal plan actually provides the training for the county health department enrollment staff. Therefore, providing enrollment services into Qualified Health Plans is a natural outgrowth of their current work, particularly as many previously uninsured adults in county based coverage programs that MediCal plans currently serve now qualify for subsidized private insurance through Covered CA.

Given this strong enrollment foundation, we had initially hoped that Medi-Cal plans could be Certified Enrollment Entities and that the staff could serve as Certified Enrollment Counselors. Unfortunately, because we are health insurers, we are barred from serving in this capacity under the federal regulation. Covered CA then anticipated that non-QHP Medi-Cal plans could be Plan Based Enrollment Entities. However, the federal regulation then barred non-QHPs from serving as Plan Based Enrollment Entities and their staff from serving as Plan Based Enrollers. Most of California’s public Medi-Cal managed care plans are not currently Qualified Health Plans in Covered CA.

Covered CA was going to issue regulations to allow non-QHP Medi-Cal plans to serve as Certified Application Counselors in March. However, the issuance of 155.225(g)(2) has delayed that, since Covered CA’s staff believes this language would prevent non-QHP Medi-Cal plans from being Certified Application Counselor organizations.

We believe this is an unintended consequence of this proposed regulation. In this letter, the undersigned describe the impact the proposed regulation may have on Medi-Cal plans in California; we also harbor concerns that Medicaid managed care organizations and other health plans in additional states operating their own Marketplaces will be prevented from serving as Certified Application Counselors. We respectfully request that CCIIO clarify that this proposed regulation is not intended to apply to public and nonprofit non-QHP issuers or their employees, provided that these plans meet any and all requirements that a state-based Marketplace may seek for purposes of their Certified Application Counselor programs.

We appreciate your consideration of our concerns and are available to discuss this issue in more detail at your convenience.

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