Proposed Regulations Governing Eligibility and Enrollment for the Individual

Executive Summary

Comment letter from NHeLP and leading health advocacy groups to Covered California on issues affecting eligibility and enrollment in the individual marketplace/exchange.

Mr. Peter Lee, Director
Ms. Thien Lam, Deputy Director Eligibility and Enrollment
Mr. David Panush, Director of Government Relations
Covered California
Re: Proposed regulations governing eligibility and enrollment for the Individual Exchange
Dear Mr. Lee, Ms. Lam and Mr. Panush:
Thank you for the opportunity to review and comment on the Exchange?s proposed eligibility and enrollment regulations for the Individual Exchange (Covered California) dated March 21, 2013. On behalf of the undersigned, we submit these group comments, which are attached. While we have a number of comments to the draft proposed regulations, we wanted to call to your attention two areas that we believe violate federal law:
  • Requiring an applicant to pay premiums to the QHP before enrollment is effectuated (§6500(b));and
  • Allowing an insurer to assist with eligibility, which would give insurers private information about income and health status that should be kept out of the hands of insurers until after people are enrolled (§6500(g)).
In addition, there are a number of provisions that are of concern, including:
  • Preventing someone eligible for traditional Medi?Cal from being enrolled in MAGI Medi?Cal and having Exchange emergency regulations govern Medi?Cal eligibility rules (§6486);
  • Creating barriers for non?applicants, such as requiring them to provide SSNs; and
  • Providing for electronic verification of residency instead of just relying on self?attestation (§6478).
We look forward to seeing a revised draft that addresses our comments and would welcome the opportunity to meet with you regarding these important regulations. We also note that several sections are marked as ?reserved? and look forward to having the opportunity to review language in these areas as well.
Thank you for your consideration of our comments. For further information, contact Elizabeth
Landsberg (916) 282?5118 or Julie Silas (415) 431?6747.
Richard Konda, Asian Law Alliance
Doreena Wong, Asian Pacific American Legal Center
Cary Sanders, California Pan Ethnic Health Network
James Crouch, California Rural Indian Health Board
Deven McGraw, Center for Democracy & Technology
Michelle Stillwell?Parvensky, Childrens Defense Fund ? California
Mike Odeh, Children Now
Kevin Aslanan, Coalition for California Welfare Rights Organizations
Sonya Vazquez, Community Health Councils, Inc.
Julie Silas, Consumers Union
Silvia Yee, Disability Rights, Education, and Defense Fund
Carla Saporta, Greenlining Institute
Beth Capell, Health Access
Lynn Kersey, Maternal and Child Health Access
Kim Lewis, National Health Law Program
Sonal Ambegaokar, National Immigration Law Center
Anne Donnelly, Project Inform
Beth Morrow, The Children?s Partnership
Masen Davis, Transgender Law Center
Elizabeth Landsberg, Western Center on Law and Poverty

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