Automatic Plan Enrollment in Covered CA

 

Senate Bill (SB) 260 requires Covered CA to automatically enroll individuals transitioning from MAGI Medi-Cal, the County Children’s Health Initiative (CCHIP), Medi-Cal Access Program (MCAP) and Medi-Cal Access Infants Program (MCAIP) into the lowest silver Covered CA plan available or the same managed care plan if this information is available to Covered CA before their current coverage ends. Covered CA will use household and income information the beneficiary reported to MC to help them enroll in a Covered CA health plan with potential financial assistance. Covered CA will notify the beneficiary in writing before enrollment in the Covered CA plan. The transitioning beneficiary can keep, change, or cancel the auto selected plan and must take timely action to secure their health plan coverage. 

 

Automatic Plan Eligibility

 

Not all MC beneficiaries who transition to Covered CA qualify for the automatic enrollment process under SB 260.

To meet eligibility, discontinued MAGI MC recipients must be eligible or conditionally eligible for APTC and includes the following:

  • MAGI Medi-Cal beneficiaries who have household income increases and/or family size changes making their income above the MAGI Medi-Cal limits, or children who have aged out and beneficiaries not eligible to Consumer Protection Programs (CPPs), or
  • Children enrolled in CCHIP who have aged out or moved out of CCHIP counties, or their family income increases making their household income above CCHIP limit, or
  • MCAP individuals who are no longer eligible for MCAP.
  • MCAIP infants with household income increases at their first annual renewal or upon reaching age 2.

 

Covered CA Plan Enrollment Process

 

EWs must continue to review the MC case of beneficiaries who are determined ineligible for MAGI MC and for potential linkage to all MC programs (CPPs and Non-MAGI) prior to discontinuance. The EW may release Soft Pause if the beneficiary clearly states either verbally or written (with documentation in the case) that they do not want a Non-MAGI MC evaluation. 
If the beneficiary is determined ineligible for all other MC programs including CPP’s and meets the requirement(s) to transition to Covered CA, the individual will be sent the “MC 239 Over Income and Not Otherwise Medi-Cal Eligible Discontinuance NOA” and will then be transitioned to CovCA. 
Individuals discontinued from MAGI MC, MCAP and CCHIP who qualify for APTC will receive both their current program’s discontinuance notice and the following notice from Covered California, the “Covered California Eligibility Notice for Medi-Cal transitioning individuals” (NOD01T). This notice will provide the Covered CA Case number, name of the health plan selected, monthly premium amount, financial help amount, and the amount the individuals would need to pay each month, their options, what actions to take, important due dates, and how to locate their application online. To avoid a gap in coverage, transitioning MC recipients will have until the end of their first month of coverage to complete their annual enrollment in the selected health plan by: 

  • Paying their premium, or
  • If they have a $0 net premium, accepting the terms and conditions of APTCs, or
  • Choosing another health plan.

Individuals with a greater than zero-dollar net premium will receive a bill from the health plan Covered CA selected and will have to pay their first month premium by the due date to keep their plan. After the enrollment is completed, their health plan carrier will send them a welcome packet which will contain plan information and their member ID card. If they do not pay their premium to the health plan by the due date, the plan will be cancelled and the carrier will issue a cancellation notice. 

 

 Referrals to Covered CA 

 

EWs must provide available information to ensure the individual understands their options and the actions they must take to avoid a gap in coverage and secure their enrollment on the auto-selected Covered CA health plan. If the individual has questions or concerns about the SB 260 Auto-Plan Selection, the EW should refer them to call Covered CA at the dedicated SB 260 telephone line, at 1-800-816-4725 to obtain information. 

Reminder: EWs should advise beneficiaries that in order to avoid a gap in coverage, the individual must select a health plan in the same month as the Medi-Cal discontinuance date in order to have their Covered CA plan start the following month. 

EWs must continue to assist discontinued MC beneficiaries transitioning to Covered CA who do not qualify for APTC financial assistance or SB 260 automatic plan selection.

 

Special Enrollment Period (SEP) for SB 260

 

individuals who qualify for SB 260 auto-plan section will receive the Covered CA "NOD01T" notice which informs the individual to take action to keep or change the selected health plan by the last day of the first month of coverage. Due to loss of MEC, those moving from MC, CCHIP and MCAP have a qualifying life event (QLE) and are provided a 60-day special enrollment period to enroll in a Covered CA health plan. If plan selection is not made, the individual can still enroll in a health plan on the Covered CA online portal during the 60 day SEP. However if the individual selects a plan through the online portal there would be a gap of one month and coverage would begin the first of the following month. If the individual does not enroll in a health plan within the SEP, they may have to wait until they have another QLE or until open enrollment to enroll in a Covered CA plan. 

 

Exceptions to SB 260 Auto-Plan 

 

Some transitioning MC beneficiaries will not have the lowest-cost silver plan automatically selected for them, they are the following:

  • Individuals with American Indian/Alaskan Native (AI/AN) status who will be places in the lowest cost AI/AN health plan.
  • Individuals with family members already enrolled in Covered CA may be enrolled into the existing health plan.

 

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