Pregnant Women Dropped From Covered California Without Notice

California Healthline

Lynn Kersey has some advice for pregnant women who bought health insurance policies from Covered California and want to keep them: Don’t report your pregnancy to the agency.

“It’s not a requirement … and it’s actually worse to do so,” said Kersey, executive director of Maternal and Child Health Access, an advocacy group based in Los Angeles County.

Why? Two of Kersey’s clients with Covered California health plans recently were thrown into Medi-Cal — the state’s health program for low-income residents — without their consent or prior notice after they reported their pregnancies to the state’s health insurance exchange.

The two women are among about 1,900 across the state who were automatically transferred from the exchange to Medi-Cal since October, even though they were supposed to have the option to stay with Covered California. The snafu was triggered by a recent policy change in Medi-Cal eligibility.

“One of the women missed a month of prenatal care,” Kersey said. “She was told she couldn’t be seen when she went to see her doctor.”

Covered California acknowledged the problem, casting part of the blame on its computer system. “We didn’t implement this as well as it should have been implemented,” said Amy Palmer, the agency’s director of communications.

That computer glitch will be fixed, but not until September, Palmer said.

A similar problem is affecting some pregnant women who purchased their plans, the federal health insurance exchange that serves people in 38 states, said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities in Washington, D.C.

It’s unclear how many women in the federal exchange have been affected by the glitch, she said, but it also stems from computer problems.

“The computer system was basically immediately transitioning them to Medicaid” when they reported their pregnancies to, Solomon said. “They should have the choice and they’re not getting it.”

Plan cancellations without notice or consent have been a persistent problem for some Covered California enrollees since 2014. In some cases, people are terminated from their plans unexpectedly. In others, they are transferred to Medi-Cal without prior notice. It’s unclear — even to Covered California — how widespread the problem is.

The situation for the pregnant California women can be traced to a recent policy change.

Usually, consumers are placed in either Covered California or Medi-Cal based on their income, with no choice in the matter, even though they can enroll in Medi-Cal via the Covered California website.

But the rules are different for some pregnant women whose household income falls between 138 percent and 213 percent of the federal poverty level, or roughly $22,100 to $34,100 for a family of two.

Under the October policy change, women who are pregnant at the time they apply for health coverage and fall into this income bracket will automatically be placed into Medi-Cal, said Lucy Quacinella, a San Francisco attorney and health care advocate for working families.

Before, they technically had a choice between Medi-Cal and Covered California, though often they were not informed of the choice, she said.

Women in the income range who already have Covered California plans before they become pregnant are now supposed to be given the choice to remain in their subsidized plans — which have out-of-pocket costs such as co-pays and deductibles — or move to Medi-Cal, which is free.

The idea is to allow them to keep their existing Covered California providers if they want, Quacinella said.

But the Covered California computer system wasn’t programmed to give them the choice, and some pregnant women were moved immediately into Medi-Cal.

“They didn’t receive notice. They just knew from one day to the next that their Covered California insurance didn’t work anymore,” Quacinella said. “It’s very stressful, very confusing.”

Although Medi-Cal is free, some women find it’s easier to get a doctor if they have private insurance. And because Covered California and Medi-Cal provider networks don’t always overlap, some of the women could no longer see the doctors with whom they had established relationships, Quacinella said.

“For some women, continuity of care is critical,” she said. “They don’t want to lose their providers.”

But after the initial shock, some women will consider the move to Medi-Cal a “blessing” because it’s cheaper, Quacinella said.

“Even with tax credits and cost-sharing reductions, it’s really hard for some families to afford the Covered California premiums or for pregnant women to afford a hospital’s labor and delivery charge,” she said.

That was the case for Kersey’s clients, who initially were distressed by the sudden loss of their Covered California plans but later decided to stay in Medi-Cal.

“One of our clients desperately wanted to get back into Covered California, but ultimately was fine with Medi-Cal, knowing there’s no delivery cost,” Kersey said.

Covered California has trained its customer service reps, insurance agents and other enrollers to explain to pregnant consumers that reporting a pregnancy could trigger a switch to Medi-Cal, Palmer said.

However, until the computer fix later this year, some women who report their pregnancy through the Covered California website still will be moved without a choice, she confirmed.

These women can get their Covered California plans back, retroactive to the date they reported their pregnancies by calling Covered California’s customer service center at 800-300-1506.

“Consumers should feel confident that their coverage continues,” Palmer said. “No consumer should be concerned about accessing care while they are pregnant for fear they do not have health coverage. They do.”

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

  • LFOldTimer

    You mean if you like your doctor you can’t keep your doctor? I thought Obama told us the exact opposite?

    And if you like your insurance plan you can’t keep your insurance plan? I thought Obama told us the exact opposite.

    But then he also told us that ObamaCare was not a tax – when by definition it was. In fact, after telling the nation that ObamaCare was NOT a tax on the George Stephanopolous Sunday news broadcast just 2 weeks before congress approved it – Obama sent his legal team to the Supreme Court to argue that ObamaCare was a tax – thereby making it constitutional.

    What a stinking liar.

    • Jacki Livingston

      Gee, a politician lied? Stop the presses! He must be the very first one in history…oh, wait, no…he just gets flack for his mistakes and no credit for his successes, and let’s not delude ourselves into thinking it has ANYTHING to do with the man’s skin color. Riiiiiiiiiiiiight. And in other breaking news: water is wet.

      • LFOldTimer

        A liar is liar – regardless of skin color.

        Clinton is a liar, Bush is a liar and so is Obama.

        But here we’re talking about ObamaCare. So Obama is the focus of attention.

        If the article reported on Monica Lewinsky or the Iraq invasion Obama wouldn’t even come up in the conversation.

        Playing the race card is just a diversion to dilute the truth.

  • Paul Lucas


  • Jacki Livingston

    SSA is becoming automated without humans to protect the people. They are so busy rigging it to make illegal money off it, they are not watching for glitches.

  • Dailysportseditor

    Strange piece (with misleading headline) for Voice of OC to post. It was distributed by Kaiser, a competitor in the health plan market. Looking at the headline, you would assume pregnant women were being completely dropped by their health plans; totally untrue. They were shifted over to Medi-Cal coverage, which is essentially free when compared to Covered California private insurance. The affected individuals were in a low income bracket and thus eligible for Medi-Cal due to the pregnancy. The computer glitch which occurred is that the affected individuals were not given the option of staying with their higher-cost private insurance plan. This story and headline is an example why reputable news outlets should not distribute corporate public relations newsletter pieces without editing them for accuracy.

    • LFOldTimer

      “The affected individuals were in a low income bracket and thus eligible for Medi-Cal due to the pregnancy.”
      Not true. Did you read the article? The cutoff for Medi-Cal for a family of 2 was about $22,100. These women fell into the income bracket above $22,100 and were shifted to Medi-Cal.
      Computer glitch? ha. Another likely government excuse. How many times have we heard that one?
      There is a certain hierachy of medical doctors. The ones who see medi-cal patients are not considered the best and the brightest. And they are becoming fewer and fewer due to the lousy reimbursement rates. Many medi-cal patients have to go to the ER for treatment since it’s practically impossible to see their medi-cal primary care doctor due to their overload of patients and overbooked schedules. That that overloads our hospital ER’s.
      ObamaCare will not survive. It will evolved into single-payor healthcare – which was the original intention anyway.

      • Jacki Livingston

        I have to disagree with you, in part. When I retired from the County, my employee health care through Kaiser was changed to Medi-Cal through Kaiser. I still see the very best and brightest rheumatologist in all of So Cal. Is it hard to get an appointment with him? Yes, because he is the guy that every doctor tells you that they would send their family to. He is the best of the best. But that has nothing to do with my being on MediCal. The quality of care that I get from my “Obamacare” versus my employee plan is absolutely no different. Kaiser was seamless. But, I may have been lucky. And, yes, there are problems with the healthcare program. There were problems with Social Security and every other newfangled program in our history. You don’t throw the baby out with the bathwater. You fix the problems. The fact that this country is light years behind other developed nations with our abysmal health care and not having coverage for every citizen is as embarrassing as our high school kids’ math scores.

        • LFOldTimer

          The problem is growing enormously. Did you hear that the United Health Care is exiting ObamaCare in about 90% of it’s enrolled states? ObamaCare is costing it $100’s of millions of dollars. And other major insurers (BCBS) are talking seriously about pulling out too. These are signs that Obamacare is collapsing under it’s own weight, as many predicted it would. The insurers are demanding huge premium increases for 2017. So much for the “Affordable Care Act”. Now illegal foreigners are getting free Medi-Cal. The failed healthcare care system that’s already eating up 20% of our GDP is going to bankrupt the nation. Obamacare only made it worse. I would rather have the Canadian healthcare system than Obamacare.

          • Jacki Livingston

            Illegal aliens cannot get MediCal, except for four things. Number one, contraception. Number two, childbirth. Number three, life threatening emergency. Number four, long term care in nursing homes. That is it. These insurers were making money hand over fist, before and delivering lousy care. I don’t feel sorry for them. United was the worst! I wouldn’t take a dog to them. Universal healthcare is necessary. If others have a way to make it work better, they should put it in the suggestion box. But we cannot go back. We have to go forward.

          • LFOldTimer

            Apparently you didn’t read about the new law the State legislators just passed.

            Illegal foreigners -under age 19 – are now entitled to Medi-Cal and can enroll in May.

            They expect it to add 170,000 new Medi-Cal enrollees.
            Yet nobody can figure out why Obamacare is hemorraging. And that’s probably a low-ball estimate – just like for the illegal driver’s licenses.

            As an American try to get your kid free unlimited soup to nuts healthcare in Mexico (or any other nation for that matter) when you reside in their country illegally.