CoveredCA

As I noted a month ago, as of January 1st, 2024, California extended Medicaid (Medi-Cal) eligibility to around 700,000 more undocumented residents:

On Jan. 1, immigrants may qualify for Medi-Cal regardless of legal status

...Milagro and her husband are among the more than 700,000 immigrants ages 26-49 expected to newly qualify for full health insurance come Jan. 1. That’s when California takes the final step in opening up Medi-Cal, the state’s health care program for low-income residents, to everyone who meets eligibility requirements, regardless of their immigration status.

Because of this, I admit to scratching my head at first when I read this article from the Redwood City Pulse:

Good grief. I have no idea how I missed this legislation. I had read about and even written about it several times over the past several years, but I sort of lost track of it since the COVID pandemic hit.

Back in 2016, California passed a bill which extened eligibility for Medi-Cal (California's brand name for Medicaid) to around 170,000 undocumented children statewide...although this ultimately ended up resulting in around 250,000 children being added to the roles.

Then, in 2019, California's expansion of Medicaid to undocumented residents moved to the next phase: Around 100,000 more young undocumented adults aged 19 - 25 years old.

Originally posted 7/26/23; updated 11/02/23

via Covered California:

Covered California’s Health Plans and Rates for 2024: More Affordability Support and Consumer Choices Will Shield Many From Rate Increase

SACRAMENTO, Calif. — Covered California announced its health plans and rates for the 2024 coverage year with a preliminary weighted average rate increase of 9.6 percent.

The rate change can be attributed to many factors, including a continued rise in health care utilization following the pandemic, increases in pharmacy costs, and inflationary pressures in the health care industry, such as the rising cost of care, labor shortages and salary and wage increases.

In July, Covered California announced the preliminary weighted average 2024 premium rate changes for the ACA individual market. They still haven't released the final/approved rates, or the small group market average rate changes, but today they released the final rate changes for standalone dental plans:

SACRAMENTO, Calif. — Covered California announced that the statewide weighted average rate change for dental coverage in 2024 will be 4.31 percent. The rate increase is the first since 2020 and continues a trend of holding costs steady for consumers.

Last month I posted an explainer about a situation in California which boiled down to a huge pot of extra revenue (~$330 million per year, give or take) being fought over between Governor Gavin Newsom and the Democratically-controlled State Legislature.

The bottom line is that this funding was intended to go towards reducing health insurance premiums for ACA exchange enrollees via Covered California as supplemental subsidies to be added on top of federal ACA tax credits...but the passage of the American Rescue Plan and the subsequent Inflation Reduction Act kind of made that moot, since the federal subsidies were made more generous than what the state subsidies would have been anyway.

As a result, Gov. Newsom decided that the extra revenue should go into the general state fund, while Democrats on the state legislature wanted to redirect it to eliminate deductibles and other types of cost sharing for ACA enrollees instead. This led to an impasse for the past several months:

This post has a long intro, but please bear with me...

Back in 2018, after the then-Republican controlled Congress zeroed out the ACA's federal "individual mandate penalty" (officially the "shared responsibility penalty"), I posted both a video and slideshow explainer about what this penalty was and why it was included in the ACA in the first place.

The very short and simplified version is this:

via Rylee Wilson of Beckers Payer Issues:

Oscar Health will exit the California individual ACA insurance market for plan year 2024 as part of a push to make its insurance business profitable. 

On a May 9 call with investors, transcribed by Seeking Alpha, Oscar Health CEO Mark Bertolini said the company is exiting underperforming markets to improve its profitability. 

"The company has been disciplined in managing its portfolio and improving the sustainability of our margins over time," Mr. Bertolini said.

Oscar Health plans to reenter the California market in the future, Mr. Bertolini said. 

Interim CFO Sid Sankaran said the California market represents less than 5 percent of Oscar Health's membership, with around 35,000 members in the state. 

This suggests that Oscar has roughly 700,000 ACA exchange enrollees nationally, FWIW.

via the California Dept. of Justice website:

Attorney General Bonta Announces $2.1 Million Settlement Against Companies Over Sham Health Insurance Plans

OAKLAND — California Attorney General Rob Bonta today announced a $2.1 million settlement against two companies, Shared Health Alliance, Inc. (SHA) and Alliance for Shared Health (ASH), to resolve allegations that they offered and deceptively advertised sham health insurance and violated insurance regulations that protect consumers. ASH, a nonprofit corporation that purported to be a healthcare sharing ministry (HCSM), created, operated, and sold unauthorized health insurance through its for-profit administrative vendor, SHA.

via Melanie Mason of the L.A. Times:

A new bill introduced in the California state Senate aims to lay the groundwork for a state universal healthcare system, proposing an incremental approach that departs from recent sweeping, and unsuccessful, efforts to reshape how Californians receive care.

Under the measure by state Sen. Scott Wiener (D-San Francisco), California would begin the process of seeking a waiver from the federal government to allow Medicaid and Medicare funds to be used for a first-in-the-nation single-payer healthcare system.

“In the wake of COVID-19’s devastation, and as costs for working people have skyrocketed, the need to provide affordable healthcare to all Californians has never been greater,” Wiener said in a statement. He touted his measure as making “tangible steps on a concrete timeline toward achieving universal and more affordable healthcare in California.”

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