Jones calls to delay 95,000 Californians being switched to Medi-Cal

California Insurance Commissioner Dave Jones says that Covered California’s cancellation of private insurance plans violates state law.

Covered California, the health insurance exchange, made headlines in December when it sent out notifications to approximately 95,000 Californians telling them that they no longer qualified for subsidized health coverage through the marketplace based on their incomes and instead were deemed eligible for Medi-Cal, the state Medicaid program. Jones claims that Covered California needs to resolve discrepancies rather than immediately switching consumers to Medi-Cal.

According to Jones, cancellation of a consumer’s coverage in the state of California is only allowed under certain conditions such as failure to pay premiums or a customer’s relocation outside of a service network. Therefore, the Commissioner stated that the notices of termination sent out by Covered California are actually in violation of state insurance law.

Covered California initially calculated eligibility based on self-reported income and 2013 tax data. Consumer advocates are arguing that such data may be an inaccurate determiner for thousands of residents who do not fall in the Medicaid bracket for 2015.

Covered California has assured consumers that anyone who has been terminated from private coverage will be immediately eligible for Medi-Cal so that they do not experience a gap in coverage. However, for some Californian’s it is not a matter of being simply covered but who is covering them.

“I was very upset about it,” said Steve Heyman, who was terminated from his Blue Shield plan, in a KPCC radio report, “Medi-Cal is not somewhere I want to be.” Heyman later discovered that a clerical error had classified him as Medi-Cal eligible.

Californians who believe that they have been erroneously terminated from their private plans may appeal the decision with Covered California. Meanwhile, Commissioner Jones may take steps to further pressure the Exchange to resolve consumer accounts.