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Covered California Resolves Pregnancy Snafu


Covered California has fixed its computer system to prevent pregnant women in a certain income range from being transferred into Medi-Cal without their knowledge or consent.

The fix comes nearly a year after the problem began.

Between October 2015 and May of this year, about 2,000 pregnant women were automatically dropped from their Covered California plans and placed into Medi-Cal, even though they had the right to stay with the state insurance exchange.

Some women lost their established doctors or missed prenatal appointments.

News of the snafu, first reported by California Healthline, prompted 16 members of California’s U.S. Congressional delegation, in an April letter, to call on Covered California to quickly fix the problem.

The fix to Covered California’s computer system, called CalHEERS, finally came on Sept. 26.

As a result, some women who are enrolled in Covered California health plans and report their pregnancies to the agency online will be able to choose between staying in their current plans and moving into Medi-Cal. Their exchange-based plans carry premiums and out-of-pocket costs. Medi-Cal is free, but it can require them to switch to new doctors.

“It is a relief,” said Lynn Kersey, executive director of Maternal and Child Health Access, an advocacy group based in Los Angeles County. “The important thing is that these women have a choice,” she said.

Kersey had clients who were among the 2,000 women transferred without consent.

This situation affects a very specific group of pregnant women who report their pregnancies to Covered California online.

Usually, consumers are placed in either Covered California or Medi-Cal based on their income, with no choice in the matter.

But the rules are different for some pregnant women whose household income falls between 138 percent and 213 percent of the federal poverty level, or roughly $27,820 to $42,940 for a family of three.

Under a policy change that took place last October, women who are pregnant at the time they initially apply for health coverage and fall into that income bracket are automatically placed into Medi-Cal.

But women in that income range who already have Covered California plans when they become pregnant are now supposed to be given the choice to remain in their plans or move to Medi-Cal.

The idea is to allow them to keep their existing Covered California providers if they want.

But the Covered California computer system wasn’t programmed to give them the choice, and some pregnant women in that situation were moved immediately into Medi-Cal.

In May, Covered California started calling women who had been switched into Medi-Cal to give them the option to return to their Covered California plans.

Customer service representatives called about 100 to 250 women each month to give them that option, said Amy Palmer, Covered California’s director of communications.

Now those calls won’t be necessary, because women should be able to choose in real time.

“We’re pleased that the change enables the consumer to have a better understanding of her choices when she reports a pregnancy,” Palmer said.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.


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