Taking a Look at California’s Program to Assist People Losing Medi-Cal Enroll in Marketplace Coverage

Taking a Look at California’s Program to Assist People Losing Medi-Cal Enroll in Marketplace Coverage

To reduce the risk that Californians may experience a coverage gap when transitioning from Medi-Cal, the state’s Medicaid program, to Covered California, its health insurance Marketplace, the state enacted Senate Bill 260. The law instructs Covered California to create a streamlined pathway to insurance for individuals who are found ineligible for Medi-Cal but likely eligible for Marketplace subsidies by selecting for them a subsidized health plan through Covered California. The program launched in May 2023, with initial enrollments taking effect in July 2023. 

In a report funded by the California Health Care Foundation, experts at Georgetown University’s Center on Health Insurance Reforms describe the critical policy and operational decisions state and Covered California officials made to implement SB260 and how these choices have affected consumers’ coverage transitions. The report aims to inform future efforts to build on SB260’s framework and to guide policymakers and stakeholders in other states considering whether and how to establish their own facilitated enrollment programs.

Key findings include: 

By March 2024, the program had facilitated the enrollment of about 112,000 Medi-Cal transitioners into Marketplace coverage. Most informants reported that implementation had gone well and were optimistic that the program is reducing burdens on consumers and meaningfully increasing take-up of Marketplace coverage.

Any state implementing a facilitated enrollment program will face two critical policy questions that will influence the numbers of consumers that enroll in a Marketplace plan and the experience they subsequently have, post-enrollment. The first is whether to enable transitioning individuals to opt in or opt out of the selected Marketplace health plan. The second is to decide what that selected plan (the “default plan”) should be.

States will need to conduct robust consumer education and outreach, informed by consumer testing and research, and collect, analyze, and publicly report data about the experiences of transitioning individuals and their coverage status. 

Although an integrated Medicaid-Marketplace eligibility system is not required for a state to operate a facilitated enrollment program, such a program demands extensive and ongoing coordination between a state’s Medicaid agency and its Marketplace. 

You can read the full issue brief here.