December 12, 2013

Covered CA and Young Children

Covered California (our state's health exchange under the federal Affordable Care Act, or ACA) now offers pre-enrollment in plans for individuals and families who are or will be uninsured, with health coverage to take effect January 1, 2014.  The ACA requires all individuals aged 18 and over who are legal residents to have health coverage that meets minimum federal standards. All Covered California plans meet these standards.  Before enrolling in plans under Covered California, families should first determine whether their children are eligible for Medi-Cal; the Covered California website will help them make this determination.

 "Mixed Families" in the Mix

Many low-income children and family members may be eligible for Medi-Cal, and families with incomes between 100% and 400% of the Federal Poverty Level (FPL) are eligible for federally subsidized premium assistance from 90% of premiums for those at 100% of FPL to 20% of premiums for those at 400%. Undocumented children and adults are not eligible to participate in Covered California but may be eligible for certain Medi-Cal benefits. Subsidies and premiums for plans purchased through Covered California can be calculated using tools on the Covered California website.

 Essential Health Benefits for Children

"Mixed-status family" refers to a household made up of individuals with different citizenship or immigration statuses, such as a family with an undocumented mom, a "lawfully present" dad, an adolescent granted deferred action through the Deferred Action for Childhood Arrivals (DACA) program, and a child who is a U.S. citizen because he or she was born in the U.S.  Each member of a mixed-status family may be eligible for a different health insurance program, while some members may not be eligible for any health insurance program. US Immigration and Customs Enforcement (ICE) confirms that immigrant parents, including those without documentation, can enroll their citizen children and other eligible family members in health insurance programs without fear of immigration enforcement. ICE clarifies that information obtained during the process of applying to Covered CA will not be used to pursue immigration action. For more information about "mixed status families" go to www.nilc.org/ACAfacts.html.

The Affordable Care Act requires that all ACA plans cover the following essential health benefits:

 What Families Should Think About as They Purchase Coverage

Ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; pediatric services, including oral and vision care.

1. Provider networks:  Do the plan networks include physicians, other providers and hospitals that young children need?  Families can find this information on the Covered California website by identifying the doctors and hospitals they use and determining which plans include those providers.  Families whose children have multiple specialists may find that none of the plans includes all their specialists in its network and may have to make choices about which providers are priorities.  
2. Out-of-pocket costs:  There are trade-offs involved in selecting a particular plan. Families will have to judge whether they are better off paying more upfront for a plan with fewer pay-as-you-go costs, or paying lower premiums for a plan with larger out-of-pocket costs whenever their children use services.  
3. Dental plans:  Child dental services are carved out from health plans and offered in separate stand-alone dental plans, so families will have to choose a separate dental plan for their children. The participating dental plans are Anthem Blue Cross of California, Blue Shield of California, Delta Dental of California, LIBERTY Dental Plan of California and Premier Access Dental and Vision.  Families who already have health coverage can buy stand-alone dental coverage via Covered California  
4.  Autism-related services:  Applied Behavioral Analysis (ABA) services for children with autism are considered an essential benefit for the plans being sold through Covered California and are included in each of these plans.  ABA services are not covered under Medi-Cal.  

How to Contact Covered California

Families can browse plans, search for providers, compare costs and apply for coverage at the Covered California website at www.coveredca.com or by telephone at 800-300-1506.  Enrollment assistance in multiple languages is available.