Sacramento Business Journal
by Kathy Robertson

Covered California deserves credit for strong enrollment in its first year, but must fix serious deficiencies in its outreach and enrollment efforts, a new study finds.

Enrollment lagged for Californians with limited English proficiency. There were cultural and linguistic problems. Funding was inadequate, given the amount of work enrollment counselors had to do, concludes a study by the Berkeley-based Greenlining Institute.

One recommendation in the study is to make sure outreach and enrollment activities are better coordinated and those who do the work get adequate funding to do it right.

Some of those problems may be resolved with Covered California’s shift to a navigator program that brings together outreach, education and enrollment assistance.

In the past, outreach and education was paid for by exchange grants to community-based organizations and others through “certified educators.” Then came certified enrollment entities and counselors who helped consumer sign up.

The navigator program brings these two sides together in what is hoped to be a more efficient approach.

“We are definitely very supportive of Covered California’s navigator program,” said Jordan Medina, a Greenlining Institute health policy fellow and co-author of the report. “We think it answers a lot of concerns community groups had enrolling people first time around.”

The change was approved by the Covered California board on June 19, along with $16.9 million in the 2014-15 budget to provide grant funding for the program from Oct. 1, 204 through June 30, 2015. A request for applications is due out this week; applications are due June 25. Awards will be announced in late August.

While the navigator program will operate during the second open enrollment period — set for Nov. 15, 2014 through Feb. 15, 2015 — existing certified educators and enrollment counselors will continue to do their work with existing funds in a parallel system through February. Only the navigator program will continue after that.

One key difference is the $58 incentive payment to sign up folks will go away after the second open enrollment period. Navigator grantees can pay folks to sign up enrollees, but the set fee offered by Covered California will end.

“These are tough issues,” Covered California executive director Peter Lee said at the board meeting. “But we want to get more people in for the dollar — we have limited funds,” he added. “We are looking at a competitive bidding process with outreach as well as enrollment goals. We need to do less on administration.”

Others like the idea.

“I think it makes a great deal of sense to try to rationalize and streamline the enrollment process,” said Albert Lowey-Ball, a Sacramento health care consultant. “It appears that the bounty did not work as well as expected.”

Medina from the Greenlining Institute wants to see the actual cost of implementing the program and what it means for organizations that will participate. The $58 fee will go away, but grantees can hire help to enroll consumers and take it out of the grant funding.

“We had concerns about the fee — and felt it was inadequate — but we’d like to see more clarity about the rules,” Medina said. “We feel the best to provide services through small groups that are part of the community, but funding is important and cost is still a problem for some.”