Home Contra Costa County Contra Costa Health Plan Will Not Participate in Covered California Exchange in 2015

Contra Costa Health Plan Will Not Participate in Covered California Exchange in 2015

by ECT

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Due to CMS regulatory requirements and the resulting cost implications and financial burdens, Contra Costa Health Plan has informed Covered California that it will not seek recertification for the 2015 Plan Year.

This difficult decision to withdraw had to be made because the new requirements pose administrative and financial burdens that could impact our ability to fulfill our mission to serve the most vulnerable people in Contra Costa County. This will affect about 1,000 of our 138,000 CCHP members. We are working with Covered CA and the California Department of Managed Health Care on plans to transition these CCHP members enrolled through the Exchange into other Health Plans in Contra Costa County by January 1.

We are disappointed that we will no longer be able to offer our plan on the Exchange. However, as the Affordable Care Act (ACA) encouraged, we continue our focus on Medi-Cal enrollment and are encouraged by the success we have had in enrolling more than 31,000 people through Medi-Cal Expansion.

We are honored to have participated in Covered CA in this sentinel first year and to be able to continue to contribute to the health care reform efforts that have brought access to health care for so many more people in need. We remain open to future consideration of participating in a state Bridge which would be focused on additional low income populations. We have previously participated in discussions with the state about the possibility of creating a Bridge and we would support these efforts.

Source:
http://cchealth.org/healthplan/exchange.php

 

FAQ

WHY IS CCHP EXITING EXCHANGE?

This difficult decision is based upon the added administrative and financial burdens which would lead to potential rate increases for 2015 due to the latest Centers for Medicare and Medicaid Services (CMS) Regulatory Guidance regarding the requirements for all health plans participating in the Exchange to offer the same product at the same rate both inside the Exchange and outside the Exchange in the commercial market for 2015. Currently, about 1,100 of our 138,000 plan members are enrolled through the Exchange and CCHP current rates are in the middle range for Plans offered in Contra Costa County.

REASON ENTERED EXCHANGE

Contra Costa Health Plan (CCHP) chose to enter the Exchange market in the absence of a Basic Health Program or BRIDGE program in California. As a county-sponsored Health Plan, CCHP has provided access to care for the community for 40 years and our mission is to serve the low-income and vulnerable population through safety net providers. We sought to create our own “bridge” for the Medi-Cal and Low Income Health Program (LIHP) members we served where churning of low-income residents between Medi-Cal and the Exchange due to income fluctuations occurs frequently. This population benefits by having a Health Plan providing care in both the Medi-Cal and Exchange and providing continuity of care in retaining the same provider in the same Health Plan regardless of changes in product.

CCHP strove to support the new California Exchange by exiting the individual and small group market outside the Exchange last year and encouraged those former CCHP members to join us or other QHPs in our County at less expensive rates to help grow Covered CA.

STATE REGULATORY ISSUES AND TRANSITION

CCHP sought and received a modification exception from California Department of Managed Health Care (DMHC) which allowed us to exit the individual and small group market outside the Exchange and still participate this first year in the Exchange individual market consistent with regulatory requirements. With the latest CMS requirements, CCHP is now diligently working with both DMHC and Covered CA for a smooth transition of our current Covered CA members during open enrollment for 2015.

COMPETING ISSUES FOR CAPACITY

Simultaneously, CCHP is expanding rapidly in Medi-Cal enrollment and will continue to grow through 2014 as the County processes the backlogged new Medi-Cal applications. As of June 1st, CCHP has grown 31,000 members in Medi-Cal this year due to population shifts (Low Income Health Program [LIHP]) and Medi-Cal Expansion. A sizeable number of our current enrolled Covered CA members have received retro Medi-Cal and have also been terminating the Exchange, choosing CCHP as their Medi-Cal provider.

 

MISSION

CCHP’s focus is on our mission and capacity to care for the vulnerable populations we serve. The new federal requirements would pose administrative and financial burdens that could impact our ability to fulfill our mission. Therefore, we will not participate in Covered CA in 2015.

We will continue to meet all Covered CA requirements and care for our Exchange members until December 31st. Additionally, we are working with Covered CA to help these members upon renewal in November to renew into the other QHP Health Plans in this County for January coverage.

FUTURE

We remain open to future consideration of participating in a Bridge in California which would be focused on the lowest income populations. We have previously participated in discussions with the state about the possibility of creating a Bridge and we would support these efforts.

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