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Covered California Provides Updates about Service Center in Webinar

The staff of Covered California hosted a webinar on January 31 about the development of the Service Center. The staff reviewed the timeline for the rollout of the Service Center, the quick sort model for warm hand-offs of callers to county service centers, protocols for handling different types of applicants, and potential payments to counties for handling Covered California plan enrollments.

The staff updated the timeline for the Service Center rollout:


The webinar also laid out several sample questions that customer service representatives will ask during the quick sort process to determine whether individuals and families are eligible for Medi-Cal or Covered California coverage. This process will gather information about the applicants’ family sizes, their ages, whether they are pregnant or disabled, and their annual income. Cutoff points for referral to a county service center include a determination that individuals are: single childless adults at or below 138% of the federal poverty level (FPL), pregnant women at or below 200% (FPL), children of adults not applying for coverage at or below 250% (FPL), or people who are elderly or have a disability.

The staff also reviewed several protocols for different types of individuals and families seeking to enroll in coverage through the Covered California Service Center. When individuals are deemed to be eligible for Medi-Cal via a Modified Adjusted Gross Income (MAGI) pathway, they will be transferred to counties through a warm hand-off, which involves the Covered California customer service representative remaining on the line with an applicant until a county service representative is available. Counties will be required to demonstrate readiness before launching these protocols and this interface, and county workers will be required to be trained in assisting applicants with enrollment in both Medi-Cal and Covered California plans.

The webinar also explored two different potential protocols in the event that a county customer service representative does not answer within 30 seconds during an attempted warm hand-off. The first option involves the Covered California representative or an automated system prompting the applicant with a series of options: arrange a call-back from the county, receive the number for the county’s direct customer service line, or remain on hold if desired. A tracer on the line would collect information about caller wait times, which would be evaluated weekly for compliance with the Service Level Agreement between Covered California and the counties. If the terms of the Agreement are not met after a certain amount of time, which has not yet been defined, the Covered California customer service representatives would begin to conduct full eligibility assessments.

Under the second option, the Covered California customer service representative would also remain on the line with an applicant during a transfer to a county representative. However, if the wait time exceeds 30 seconds, the Covered California representative would offer to conduct a full eligibility assessment or provide the caller with the phone number for the county’s service center to call it directly.

The Covered California staff are recommending the first option at this time, with a subsequent review of the process and the possibility to adopt the second option if necessary. In either case, Medi-Cal enrollees’ information would be forwarded to counties for final enrollment and case management. If individuals are deemed likely to be Medi-Cal eligible through a non-MAGI pathway, they will also be referred to counties.

Notably for the initial Covered California open enrollment period (October 2013 – March 2014), if individual members of a family in one household are eligible for different programs, the Covered California customer service representative will conduct a full assessment for all family members. Those eligible to purchase coverage through Covered California will be enrolled in a plan, and coverage will begin for family members deemed eligible for Medi-Cal via MAGI, with data being transferred to counties for a final Medi-Cal eligibility review. In the case of a special enrollment, which would occur outside of the Covered California open-enrollment period, a Covered California representative would conduct a quick sort for the muli-program family and then initiate a warm hand-off to a county customer service representative for full enrollment into the appropriate programs for the individual family members.

In the case that the Covered California Service Center receives incomplete paper applications or applications in need of further verification, a customer service representative will follow up with an applicant via paper, phone, fax, or email to complete the application. The Covered California Service Center will refer applicants to counties if they are eligible for Medi-Cal.

Finally, the Covered California staff have proposed payments to counties for the work that they will do to complete Covered California enrollments. They have recommended the assiter payments for enrollments: $58 per successful application and $25 per successful renewal. The staff also indicated that they would explore advanced payments based on estimated application volumes, with subsequent adjustments to payments that will based on actual application volumes.

Prepared by John Connolly (2/1/13)


For a the webinar materials: http://www.healthexchange.ca.gov/StakeHolders/Documents/CA%20Service%20Center%20Protocols%20Presentation.pdf


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