CHA News Article

Covered California Releases Draft Single-Streamlined Paper Application
One application will allow consumers to apply for Medi-Cal/CHIP, advance premium tax credits and cost-sharing reductions

The Affordable Care Act (ACA) makes a number of changes to simplify the Medicaid enrollment process, including requiring a “no wrong door” approach to enrollment. As part of these changes, beginning in 2014 all states will be required to use a single-streamlined application, meaning that people who are seeking health coverage will only need to complete one application in order to learn which programs they and their family members can enroll in. In California, the California Department of Health Care Services (DHCS) and Covered California have partnered to create a single-streamlined paper application that will allow consumers to apply for a range of health coverage options, including Medi-Cal/CHIP, advanced premium tax credits (subsidies) and cost-sharing reductions, to help purchase coverage under a Covered California Qualified Health Plan. Consumers can apply online, by phone or by paper when open enrollment begins Oct. 1.

A draft version of California’s single-streamlined paper application is attached. Covered California has indicated that the draft is still under federal review with approval pending, and may not be available by Oct. 1. CHA will announce in CHA News when the single-streamlined paper application has been approved and is made available to stakeholders. Until it is available to stakeholders, hospitals should proceed with enrolling individuals into health care affordability programs under current processes. Only staff who are Certified Enrollment Counselors will have access to the CalHEERS online application portal beginning Oct. 1; all others will be required to use the single-streamlined paper application once it is available.

Following is an overview of the single-streamlined paper application, including the guiding principles used to create it, the overall development and testing processes, and other important details:

Eligibility and Enrollment Guiding Principles:

Through a “no wrong door” approach, promote maximum enrollment into coverage.

Facilitate a smooth enrollment process beginning with the use of a single-streamlined application and seamless renewal process.

Present information in a manner that is accurate, accessible, understandable and transparent to consumers to inform and educate them.

Continue to learn and adjust strategies and tactics based on input from national partners, California stakeholders, ongoing research, evaluation and measurement of the programs’ impact on awareness and enrollment.

Application Length:

The paper application is three pages per individual.

Total application package (including introductory material, privacy statement, optional questions, attachments and frequently asked questions) is 33 pages.

The web version of the application allows consumers to skip questions that aren’t relevant to them.

Development Process:

The draft application has been tested through one-on-one consumer interviews in several cities around California in five languages.

Covered California utilized the following applications as a baseline for development:

  • Federal Application for Insurance Affordability Programs
  • Healthy Families and Medi-Cal for Families Application (MC 321 HFP)
  • Application for Medi-Cal (MC 210)
  • Overall application is at a 9th grade reading level.
  • The paper application will be available in the 12 Medi-Cal threshold written languages: English, Spanish, Chinese, Vietnamese, Korean, Tagalog, Russian, Armenian, Farsi, Khmer, Hmong and Arabic.


The Center for Health Literacy (CHL) researchers conducted a series of one-on-one consumer testing with adults between June 2013 and August 2013. Interviews were conducted in Sacramento, San Francisco and Los Angeles.

One-on-one interviews were conducted in English, Spanish, Mandarin Chinese, Cantonese Mandarin and Vietnamese.

One-on-one consumer testing focused on finding out if participants:

  • Understood the purpose of the application;
  • Had difficulty completing the application; or
  • Had difficulty understanding what information was needed.

Key Findings From Testing:

Application look and feel:

  • Widely accepted from most participants from the English and Spanish-speaking and Asian communities.
  • Most participants did, however, find the application somewhat lengthy.
  • Covered California and DHCS consolidated data elements and revised instructions and questions in order to reduce the application length as much as possible.

Application purpose:

  • All English-speaking participants and most non-English-speaking participants understood that the state of California created Covered California.
  • Most understood that they could use the application to determine whether they qualify for Medi-Cal and for financial assistance through Covered California.

Key Concerns:

Social Security number:

  • Most consumer testing participants understood about providing their Social Security  number (SSN), but several questioned why their SSN was necessary or stated that they would be uncomfortable providing it.
  • Stakeholders requested that SSNs be required and verified for applicants applying for coverage and not for other individuals. The application filer should be notified that their SSN will be used only for purposes of income verification, cannot be shared for any other purposes, and will only be used for eligibility determination.
  • Covered California added clarifying and reassuring language regarding the use of a consumer’s SSN to help reduce consumer concerns about safeguarding personal and financial information.


Based on stakeholder feedback, Covered California added explicit language that informs the consumer that the application is also for the Medi-Cal program.

Authorized representative language:

  • All of the Spanish-speaking participants understood the use of the term “authorized representative.” Several English and Chinese-speaking participants and most of the Vietnamese-speaking participants could not explain this term.
    • Covered California reworded this section of the application and included language that clearly defines the role of an “authorized representative.”

Optional race or ethnicity:

  • Stakeholders requested using the U.S. Census 2010 question on race, which includes the new Department of Health and Human Services categories to expand the race category options by adding three additional categories (Hmong, Laotian and Cambodian).
  • Covered California supports the use of the ethnicity options contained in the Healthy Families and Medi-Cal for Families Application (MC 321 HFP); however, online application functionality does not currently allow for additional race options. Covered California will continue to work with stakeholders and make efforts to include additional race options in future iterations of the online and paper applications.

Sexual orientation and gender:

  • The application only identifies a male or female gender as data elements. Stakeholders requested that, where appropriate, the application should collect a comprehensive range of demographic information, including sexual orientation and gender identity. This information is important to identifying lesbian, gay, bisexual and transgender populations for:
    • Outreach planning;
    • Compliance with non-discrimination requirements; and
    • Customer satisfaction evaluations.
  • Based on Stakeholder feedback, Covered California is working with DHCS to:
    • Conduct surveys to gather additional demographic information that is currently not collected on the application; and
    • Add optional questions to collect comprehensive sexual orientation and gender identity data elements. However, implementation of additional sexual orientation and gender questions is targeted to take place in the 2015 benefit year.

Frequently Asked Questions (FAQs) Section:

Based on stakeholder feedback, the FAQs section has been revised to add additional questions to help consumers through the applications process and provide additional Insurance Affordability program information. Covered California and DHCS added over 10 additional questions and answers to assist consumers.

One-on-one consumer testing participants felt the FAQs were helpful and informative.

The majority of participants stated that they would likely read the FAQs section when applying for coverage.

Questions about the single-streamlined paper application can be directed to the Covered California Service Center at (800) 300-1506, Monday through Friday, 8 a.m. to 6 p.m., and Saturday, 8 a.m. to 5 p.m.