CHA News Article

Covered California Will Demonstrate CalHEERS Online Application Portal This Week
Webinar set for Sept. 26 at 10 a.m.

Note: This webinar will demonstrate how to use the CalHEERS portal to help enroll individuals into health coverage. Hospital staff trained as Certified Enrollment Counselors will be allowed to enroll individuals into health coverage using the online application portal on Oct. 1.

Covered California will host a webinar Sept. 26 at 10 a.m. (PT) to demonstrate the use of the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) online application. To register for the webinar visit https://goto.webcasts.com/starthere.jsp?ei=1023010.

The Affordable Care Act (ACA) requires that states provide a “no wrong door” approach to applying for and enrolling in health coverage affordability programs. In addition, the ACA requires a single-streamlined application that allows consumers to apply for any applicable health coverage affordability program (e.g., Medi-Cal, Children’s Health Insurance Program), and advance premium tax credits (subsidies) and cost-sharing reductions to purchase health coverage in the exchange marketplace. The CalHEERS online application portal’s key functions include eligibility determination, intake and application processing, verification, plan comparison, selection and enrollment, renewals, appeals, exemptions and disenrollment. Intended to be user-friendly, the CalHEERS online application portal is being designed to help individuals make informed choices about their health coverage options. 

CalHEERS, jointly administered by Covered California and the California Department of Health Care Services, is the online “one-stop” portal through which individuals and families can apply, be determined eligible for, and make a health plan selection for:

  • Medi-Cal/CHIP; and/or
  • Advance premium tax credits and cost-sharing reductions to purchase coverage under a Covered California Qualified Health Plan (QHP).

The CalHEERS online application portal will also enable:

  • Employees of participating businesses to select among small group coverage options; and
  • Individuals with incomes more than 400 percent of the federal poverty level to purchase unsubsidized coverage from a Covered California QHP.

Access to CalHEERS is via the Covered California website, which is available in English and Spanish. CalHEERS also will feature “web chat” for online applicants who need assistance.

Additionally, the Covered California website offers fact sheets in Arabic, Armenian, Chinese, Farsi, Hmong, Khmer, Korean, Lao, Russian, Tagalog and Vietnamese. Covered California call centers will be located throughout the state and will be staffed with customer service representatives fluent in 12 languages to guide Californians through the enrollment process. California’s county-based Medi-Cal eligibility personnel will also assist consumers that apply for, and enroll in, all health coverage affordability options, including Covered California QHPs.  County eligibility personnel will support consumers applying in-person, by phone and by mail.

To achieve the shared goals of expanded health coverage and reduced uncompensated care, hospitals and their staff are encouraged to participate in Covered California’s Certified Enrollment Assistance Program and become proficient in using the CalHEERS online application portal. According to Covered California data, nearly 70 percent of the newly eligible individuals may require in-person assistance to apply for health coverage. To begin enrolling individuals in Covered California, hospitals must first become registered as a Certified Enrollment Entity (CEE), complete the required training for the CEE, and ensure that their eligibility and enrollment staff become Certified Enrollment Counselors (CECs). Once hospital eligibility and enrollment staff complete the required training and pass the certification exam, they will be provided login information to create a profile in CalHEERS to begin enrolling individuals into health coverage via the online application portal. Only staff certified as a CEC will have access to the CalHEERS online application portal beginning Oct. 1.; all others will be required to use the single-streamlined paper application

Covered California estimates that it will recruit 3,200 CEE organizations and 20,000 individual CECs statewide. Hospitals and their staff will likely represent a significant portion of that group.

 

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