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October Exchange Board Meeting: Strategic Visioning, NPRM Comments, and Design Options

On Friday, the California Health Benefit Exchange held its monthly meeting in Sacramento (agenda). This was the first meeting in which Peter Lee was the Executive Director of the Exchange. Diana Dooley, on behalf of the Board and participants, thanked Pat Powers for all of her work leading up to the start of a permanent Executive Director.

Peter Lee started by thanking the Board, the staff and other partners who have provided support. He commended them on their phenomenal work to date in setting up California’s Exchange.

Report from Executive Director

The Board is actively building and recruiting staff. They are reviewing a firm to do recruiting for exempt positions listed in the legislation. The Board is also in the process of engaging in a major RFP for setting up the IT. Selecting the firm that will write the RFP has been an active process for the Board and its partners. They have selected a California-based company called “ClearBest” who has also worked on the County SAWS systems and has experience in procurement and implementation.

AB 1296 was signed into law. It related to eligibility and enrollment issues and is related to the Exchange so the Board will work on it in an ongoing process.

Strategic Visioning

The October 17 version of the vision and mission statements is a result of months of stakeholder engagement, input, discussions, and work. Lee reminded us that in the end, the Exchange will be measured by what is delivered, not by what is written. The Exchange will be accountable for the results that it produces in terms of bettering the health of Californians while reducing costs.

The following revisions to the statement were agreed upon (additions are underlined):

Vision: Improve the health and healthcare and its affordability for all Californians.

Mission: The California Health Benefit Exchange will increase the number of insured Californians, improve quality, and lower health care costs by facilitating an innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value.


  • Consumer-focused: The Exchange puts the people it serves – patients, and their families – at the center of its efforts, recognizing the diverse cultural, language, economic, educational and health status needs of Californians, and provides an easily accessible, consumer friendly experience for all.
  • Affordability (no changes)
  • Catalyst (see below)
  • Integrity: The Exchange will earn a reputation for trust, speed, agility, responsiveness, transparency, reliability and cooperation.*
  • Partnership (no changes)
  • Results (see below)

Public Comments

Stakeholders asked that the Board define “value.” Belshe mentioned that it is cost, quality and service and Ross argued that value is subjective to the person.

Lee suggested two amendments based on public comments wanting prevention and wellness emphasis:

  • Catalyst: The Exchange will foster innovation in the provision of high-value health care, the promotion of prevention and wellness, the reduction in healthcare disparities through its insurance coverage and stimulating change in the health care system.
  • Results: The Exchange will measure its results based on how it contributes to expanding access, improving health care quality, promoting better health, reducing disparities and reducing costs for all Californians.

All changes were approved.

Notice of Proposed Rulemaking and Request for Information Comments

Deborah Kelch explained that the due date for comments on the federal NPRM was extended from September 28 to October 31. Since the Board planned on submitting by the original due date, comments were near-ready at the last meeting on September 27. Since then, they have consulted with more stakeholders and other state agencies to make some changes to verbiage (see cover letter). Some entities will be submitting their own comments.

Leslie Cummings outlined some of the comments being submitted. She explained risks associated with advanceable tax credits. In addition, she stated the importance of allowing an individual to let the Exchange know whether their income will be different to what is was the previous year to avoid having to pay back subsidies at the end of the year.

Cummings explained that employers must offer employees affordable coverage. According to ACA, “affordable coverage “ is defined as 9.5% income of an individual’s income (regardless of whether or not this is actually affordable to the person). If the employee is eligible for this “affordable” coverage, their dependents will not be eligible for Exchange subsidies. In addition, someone who is enrolled in COBRA is ineligible for tax credit.

Exchange Design Options

Pat Powers provided a presentation on the Exchange design options. For now, they are referring to the system as the “California Affordable Coverage Enrollment System Design Plan.” At the September Board meeting, the Board and participants focused on eligibility and enrollment systems to present options from advocacy community. At this meeting, the goal was to talk about systems rather than who does what.

Design goals (listed in the presentation) include: no wrong door, cultural and linguistic appropriateness, seamless and timely transition between programs, minimize burden of establishing and maintaining eligibility, security and privacy, real-time eligibility determinations, transparency and accountabilities, no gaps in coverage, informed choices. At the meeting, cost and effectiveness was added as a goal.

The Board plans to ask IT vendors to acquire a contractor to design something that meets ACA requirements. Vendors must provide pricing on functionality, both core functions and additional functions that are not required under ACA (like individual premium aggregation). Right now, the Exchange allows individuals to directly pay health plans. Another possible option would be a function that allows the Exchange to collect subsidies. Vendors will be asked to price these different functions to decide whether they should be incorporated. The Board will also be informing venders that they would like to incorporate MRMIB and DHCS in the online shopping experiences.

If the Exchange’s eligibility and enrollment system uses centralized MAGI rules determinations, they could leverage the 90:10 Medicaid IT match and offer simplicity and consistency. All other functions listed in the presentation are required functions or required support functions (such as the client index).

Kim Belshe suggested there be a presentation on UX 2014 at the next meeting to link people to “backroom functionality” aspect of the Exchange.