Health
Covered California Continues to Terminate Some Customers
By Emily Bazar, Kaiser Health News
It wasn’t until a doctor ordered medical tests for Adriana Vitale that she discovered her Covered California coverage had disappeared.
“I was shocked. I was crying. I was depressed,” said Vitale, 61, of Downey, California
Her insurance had been dropped, even though she had paid all her premiums on time.
She’s not the only one. A number of people who have signed up for Covered California coverage have been dumped from their plans unexpectedly, without explanation — even though their premium payments were up to date.
Others were shifted into Medi-Cal without approval or consent. They found out after the fact.
It’s been a persistent, but apparently unquantified problem, since 2014.
In Vitale’s case, she went to the hospital in December for a bleeding ulcer. Her daughter called the insurance carrier, Blue Shield, to confirm that her mother’s follow-up tests would be covered.
“They said, ‘We don’t have anyone by your mom’s name covered by Blue Shield. But we have all these medical bills in her name,’” the daughter, Kathy Castilla, recalled.
It took an administrative law judge in late December to resolve the problem. He ordered Vitale’s policy reinstated.
He noted that neither Blue Shield nor Covered California could explain why Vitale’s policy had been terminated without her request.
“The failure to be able to explain these discrepancies casts doubt on Blue Shield and/or [Covered California] record keeping as it applies to appellant’s coverage,” he wrote.
Several other customers whose paid-up policies disappeared talked to California Healthline about their plight, as did health care advocates who help them unravel the bureaucratic knots.
The evidence is anecdotal. Not even Covered California knows how many people might be affected.
“We are not aware of anything that would result in the terminations of a large number of consumers without notification, or of any problems with our process of notifying consumers who are deemed eligible for Medi-Cal,” spokesman Larry Hicks said.
When pressed further on whether Covered California is aware of the termination problem and if so, how many people it affects, Hicks issued this statement: “While we want every enrollment and transition to be as smooth as possible, we know that with 1.5 million consumers, there will be times when issues come up that need to be resolved. We deal with these on a case-by-case basis as we discover them and, where appropriate, look for ways to improve our existing processes.”
No one seems to know what’s causing these terminations. Nor is it clear whether they’re a result of errors committed by Covered California or the health insurance plans — or both.
Blue Shield declined to comment on Vitale’s case, citing privacy concerns, but said there are several reasons why someone’s plan might be terminated. These include non-payment of premiums, not providing proof of citizenship and changes in income that would make the person ineligible for a subsidized Covered California plan, the insurer said.
None of those seem to apply to Vitale.
“Blue Shield is committed to providing coverage to all Californians — this includes working closely with Covered California to decrease the state’s uninsured rate,” said spokesman Clinton McGue.
Covered California’s Hicks suggested that consumers who face problems with their coverage and are unable to resolve it with their insurer contact the exchange’s customer service center at 800-300-1506.
Vitale’s daughter said she tried that. The service center acknowledged an “error,” but when she asked whose it was, “they didn’t want to tell me,” she said. The agent did tell her the problem would “take a while to fix.”
The family turned to Neighborhood Legal Services of Los Angeles County, which helped them take the case to the administrative law judge.
But Vitale still hasn’t had her medical tests, in part because it has taken so long to get her coverage reinstated, despite the judge’s order.
“I wish they would never do this again to another person,” she said. “It’s a terrible thing.”
Wendy Heath of San Diego also contacted Covered California’s help line after her policy was dropped. She said she had renewed her Health Net policy through the exchange and paid her January premium. When her February invoice didn’t show, she called Health Net.
“They said, ‘You don’t need to pay us. As a matter of fact, we’ve refunded the amount you paid for January,’” Heath, 39, recalled. “They said, ‘Your plan was canceled by Covered California.’”
When she called Covered California, she said, a representative could only acknowledge that “we’ve seen the issue” with her case. Eventually, she got her coverage restored with the help of a community service group, San Diegans for Healthcare Coverage.
In the meantime, she had canceled two physical therapy appointments, afraid she might not be covered, she said.
Health Net spokesman Brad Kieffer said policyholders having trouble with their coverage should call the plan at 888-926-4988.
“This is not the experience we want for our members,” he said. “Anybody who feels that this has happened to them can call us and we’ll look into it and resolve the matter on their behalf.”
California Black Media
Stakeholders Warn Lawmakers of Expanding Aging Population; Older Black Californians Included
The California Commission on Aging (CCoA) hosted its second annual forum focused on challenges facing Californians over 65 years old. Titled “Aging and Disability Issues: What Legislative Staff Need to Know for 2024,” the virtual event was organized to bring awareness to lawmakers that California’s aging adults are living longer and to emphasize the importance of developing policy to support this growing population, according to organizers.
By Antonio Ray Harvey, California Black Media
The California Commission on Aging (CCoA) hosted its second annual forum focused on challenges facing Californians over 65 years old.
Titled “Aging and Disability Issues: What Legislative Staff Need to Know for 2024,” the virtual event was organized to bring awareness to lawmakers that California’s aging adults are living longer and to emphasize the importance of developing policy to support this growing population, according to organizers.
This year’s meeting included the perspectives of gerontologists and other subject-matter experts who provided data and insights critical to informing policy.
Former Assemblymember Cheryl Brown (D-San Bernardino), who chairs the CCoA’s Executive Committee, began the discussion.
“The landscape of California is changing. Aging is changing and it’s changing California,” Brown said. “Older adults are living longer, and the cohort is becoming more ethnically diverse, underscoring the need to develop culturally, appropriate services.”
The discussion encompassed a range of topics including planning for long-term care, assisted living, enhancing healthcare quality, technology use, services for senior adults with disabilities, state budget considerations, and the best policies and practices to help aging adults stay healthy, active, independent, and confident.
The CCoA acts as the principal advocate for older Californians and as a catalyst for change that supports and celebrates Californians as they advance in age. The CCoA advises the Governor and Legislature, along with state, federal, and local agencies on programs and services that affect senior adults.
Statewide organizations that participated in the event included LeadingAge California, Disability Rights California, California Foundation for Independent Living Centers, and California Collaborative for Long-Term Services and Supports.
In addition, representatives and staff members of Choice In Aging, Age Watch Newsletter, California Elder Justice Coalition, California Association of Area Agencies on Aging, and the California Long-Term Care Ombudsman Association were presenters during the 90-minute discussion.
“In California, we know that older adults are underserved and unserved relative to their needs,” CCoA Executive Director Karol Swartzlander said. “In stark terms, we know that 4% of older adults who need service actually receive services.”
According to the California Department of Aging (CDA), California’s aging population is expected to reach an estimated 4.5 million individuals ages 60 to 69 and 4.2 million senior adults ages 70- to 79 by the year 2040, based on information from CDA’s Master Plan for Aging.
Recognizing that the state’s 65-plus population is projected to grow to 8.6 million by 2030, Gov. Gavin Newsom issued an executive order calling for the development of the MPA.
Debbie Toth, from ChoiceInAging, said the MPA is a model of “how we can do better” to service the needs of older adults. ChoiceInAging, Toth said, “is going to be shopping accessible transportation and rate increases for adult day healthcare.
“But we need to have legislation to do it,” Toth told legislative staff members.
A 2016 California Health Report (CHR) revealed that by 2030, 18% of the state will be 65 or older. Projections in that study also indicated that 52% of these older adults would be from diverse minority groups but “no population is expected to be harder hit than African Americans,” the report stated.
California Black Media
Asm. Akilah Weber Introduces Bill to Protect Terminally Ill Californians
On Feb. 7, Assemblymember Akilah Weber (D-La Mesa) introduced legislation, Assembly Bill (AB) 2180, designed to ensure that terminally or chronically ill people living in California can afford their life-saving medications.
If passed, the law would require California health plan providers, insurers and pharmacy benefit managers (PBMs) to count the value of financial assistance provided by subsidy programs towards a terminally ill patient’s deductible and out-of-pocket expenses.
By California Black Media
On Feb. 7, Assemblymember Akilah Weber (D-La Mesa) introduced legislation, Assembly Bill (AB) 2180, designed to ensure that terminally or chronically ill people living in California can afford their life-saving medications.
If passed, the law would require California health plan providers, insurers and pharmacy benefit managers (PBMs) to count the value of financial assistance provided by subsidy programs towards a terminally ill patient’s deductible and out-of-pocket expenses.
“When insurers and PBMs do onto count the value of copay assistance toward cost-sharing requirements, patients often experience “a copay surprise” at the pharmacy counter and may be forced to walk away without their needed medication because they cannot afford it,” wrote Weber in a statement.
Over 80 patient advocacy organizations, medical foundations and other groups applauded Weber for introducing the legislation.
“The All Copays Count in California Coalition commends Dr. Weber for championing legislation that will improve patient access to medications and protect the most vulnerable Californians from harmful and deceptive insurance schemes that raise patient costs,” said Lynne Kinst, Executive Director of Hemophilia Council of California (HCC), which is a cosponsor of the bill.
According to the HCC, an estimated 70% of patients “abandon their prescription medications when their out-of-pocket costs reach $250 or more.
Bay Area
Who Are the Top Donors in the Alameda County District 5 Supervisor’s Race?
District 5 covers West and North Oakland and includes Emeryville, Berkeley, Piedmont and Albany. The five-member Board of Supervisors sets the county’s budget, governs its unincorporated areas, oversees the sheriff, Alameda Health System, and the mental health system. Voting in this election has already begun. Most of those living in the district will have been mailed paper ballots. Residents can also vote in person on March 5, the last day voting is open. If no candidate gets more than half of the votes, the top two candidates will face off in the general election in November.
About $342,500, a little less than half of the approximately $705,000 raised in the race so far, has come from just 30 sources.
By Zack Haber
Nine candidates are running to represent District 5 on the Alameda County’s Board of Supervisors.
District 5 covers West and North Oakland and includes Emeryville, Berkeley, Piedmont and Albany.
The five-member Board of Supervisors sets the county’s budget, governs its unincorporated areas, oversees the sheriff, Alameda Health System, and the mental health system.
Voting in this election has already begun. Most of those living in the district will have been mailed paper ballots. Residents can also vote in person on March 5, the last day voting is open. If no candidate gets more than half of the votes, the top two candidates will face off in the general election in November.
Candidates in Alameda County are required to report all of their campaign donations. The public can search these filings through an online portal.
Looking through the county’s campaign finance reports, we found that residents, businesses and other organizations, such as unions, have donated around $705,000 in total to all candidates as of Feb. 13. In three cases, candidates donated to their own campaigns, but we excluded these figures.
Of the nine candidates, John Bauters, the former Emeryville Mayor and current City Councilmember, has raised the most, about $167,500. Alameda County Board of Education Trustee Ken Berrick has raised about $157,500. Piedmont resident and East Bay Rental Housing Association board member Chris Moore has raised about $129,000. Oakland City Councilmember Nikki Fortunato Bas has raised about $130,000; and Berkeley City Councilmember Ben Bartlett raised about $103,500.
The other candidates, Omar Farmer, Gregory Hodge, Gerald Pechenuk and Lorrel Plimier have all raised much less than the other candidates. So far, Hodge has raised about 11,500 and Plimier has raised about $5,500. Farmer and Pechenuk haven’t reported receiving any campaign donations.
While there were over 525 donations to candidates in total, of these, about $342,500 or a little less than half of the about $705,000 in total donations, came from just 30 sources. For the purposes of this article, we’ve defined these 30 donations as large donations—$5,000 or more. Bartlett, Bas, Bauters, Berrick, and Moore have received large donations, while Farmer, Hodge, Pechenuk and Plimier have not.
Below is a listing of each reported large donation, and information we could find about its source. We ordered the list in alphabetically by candidate name.
Large donations to Ben Bartlett:
Mukemmel ‘Mike’ Sarimsakci of Millbrae donated $10,000. Sarimsakci is a real estate developer and the CEO of Alterra Worldwide, a commercial real estate company. Man Hao Chen of San Francisco, CEO and founder of crop farming company Sunbber, inc., donated 5,000. Bao Le of Fremont, CEO of medical marijuana company Hemp.co, donated $5,000. Retired Berkeley resident Frank Brown donated $5,000.
Large donations to Nikki Fortunado Bas:
Alameda Labor Council AFL-CIO Unity, which represents about 135,000 healthcare, construction, service, education, and manufacturing workers, donated $20,000. Building and Construction Trades Council of Alameda County donated $20,000. Quinn Delaney of Piedmont, founder and the board chair of Akonadi Foundation, donated $20,000. Wayne Jordan of Piedmont, husband to Delaney, Akonadi Foundation board member, landlord and founder and president of Jordan Real Estate Investments, donated $20,000. California Working Families Party, a “grassroots party for the multiracial working class,” donated $10,000. Bas also received a $5,000 donation from the San Francisco crop farming company, Sunbber, inc. Man Hao Chen, who donated to Ben Bartlett’s campaign, is the CEO of Sunbber. IBEW Local 595, a union representing about 2,000 electric workers in Alameda and San Joaquin/Calaveras counties, donated $5,000. UA Local 342, a union representing around 4,000 workers in the pipe trades industries in Contra Costa and Alameda counties, donated $5,000.
Large donations to John Bauters:
Maryam Asefinejad of Orangevale, board member of Teranomic Software, donated $20,000. Fred J Bauters of Lisle, IL, relative of John Bauters, donated $20,000. The International Association of Firefighters Local 55 donated $11,000. State Assemblymember Buffy Wicks donated $10,000 from her reelection campaign. Nick Josefowitz of San Francisco, commissioner with the Metropolitan Transportation Commissionand co-founder of the nonprofit Permit Power, donated $10,000. Daniel Golden of Santa Monica, who works in sales at the pharmaceutical company Bausch Healthcare, donated $5,000. Marc Hedlund of Berkeley, founder of the investment company Tenuki Moves LLC and board treasurer of the nonprofits Bike East Bay and Code 2040, donated 5,000. The California YIMBY Victory Fund donated $5,000. Steven Berger of Berkeley, president of the company NYF Properties, inc. donated $5,000.
Large donations to Ken Berrick:
Megan Salazar of Richmond, director of advocacy for the Bay Area based nonprofit, Just Advocates which Ken Berrick founded, donated $13,520. Christopher Ciauri of London, England, CEO of the software company Unily, donated $17,500. Betsy Maushardt, unemployed resident of Santa Cruz, donated $10,500. Christopher Seiwald of Alameda, member of the University of San Francisco’s Board of Trustees and investor with the Berkeley Angel Network, donated 5,000.
Large donations to Chris Moore:
Quintin Anderson of Redwood City, Chief Operating Officer with Granite River Labs, donated $20,000. Madeline Moore, retired resident of Walnut Creek and relative of Chris Moore, donated $20,000. Philip Dreyfuss of Oakland, partner with Farallon Capital Management, a San Francisco based hedge fund, donated $20,000. Fred Morse of Piedmont, landlord with Morse Management, donated $15,000 through individual and company donations.
Justin Wallway of Oakland, landlord with JDW Enterprises, donated $10,000.
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