COVID-19 Public Health Emergency Ending
Update: Covered California announced on that they will allow the public health emergency qualifying life event to be used through , giving people until the end of the month to still sign up or make changes to their health coverage.
On the federal government declared the COVID-19 pandemic to be a public health emergency. That emergency declaration is ending on , resulting in big changes that affect Medi-Cal enrollees and people wanting to obtain health insurance. These changes aren’t really new—we’re just going back to how things worked before COVID—but we’ve been operating under emergency measures for so long that it’s important to remind everyone how the normal rules work.
The Affordable Care Act guarantees coverage to people regardless of any preexisting health conditions, but that poses a problem: With coverage guaranteed, people could save money by not getting insurance until they get sick. Insurance works by having a broad pool of people, healthy and sick, all paying premiums. If only sick people bought insurance, the premiums would have to be much higher, because there’d be far fewer people paying premiums to cover the same amount of claims. To avoid this adverse selection problem, the ACA does the same thing that employer-sponsored group health plans, which also have no preexisting condition limitations, do: Enrollments are limited to a brief annual open enrollment period, plus a small window when people can sign up after a qualifying life event like having a child or getting married. Additionally, coverage doesn’t begin immediately after you sign up. For Covered California, the annual enrollment period is November 1 to January 31, the qualifying life event enrollment window is 60 days from the QLE, and coverage doesn't begin until the following month (or January 1 during open enrollment, if later).
Effect on Covered California
Covered California has been allowing people to use the public health emergency as their qualifying life event, effectively letting people sign up and make changes to their coverage year-round. After the public health emergency ends on , people can only sign up or change plans if another qualifying life event applies. If you’ve held off on buying health insurance and are more than 60 days from a qualifying life event, you only have until to do so; after that you’ll have to wait until open enrollment to buy coverage that starts next year. Call us before time runs out, and keep in mind that, due to a major system upgrade, Covered California’s system will be down from until , during which time we cannot sign people up nor make any changes.
Effect on Medi-Cal
During the COVID-19 public health emergency, states were prohibited from dropping people from the Medicaid program (called Medi-Cal in California), even if they no longer met the qualifications for the program. That prohibition ended on , so Medi-Cal has resumed sending annual renewal questionnaires and will begin dropping people who do not respond or no longer qualify. Questionnaire due dates coincide with the anniversary of being enrolled into Medi-Cal. The first Medi-Cal non-renewals will be effective on . Medi-Cal recipients should go to https://KeepMediCalCoverage.org for information on how to update their information with Medi-Cal and on what to do if they get a letter saying they will be dropped from the program.
If you are dropped from Medi-Cal, you will automatically be transitioned into the lowest cost silver plan available to you through Covered California. You will have one month after your Medi-Cal coverage ends to accept the new plan or choose another one, and make the first month’s premium payment, if any; otherwise the Covered California coverage will not take effect and you will not have health coverage. If you do not obtain coverage within 60 days of being dropped from Medi-Cal, you will have to wait until open enrollment to sign up for coverage that takes effect the following year. Call us and we can help you pick a plan and make a payment so that you can retain health coverage for you and your family.