By Marianne LeVine
Two months before the Covered California health insurance exchange opened, San Mateo County jumped at the chance to get people trained to be certified enrollment counselors.
But while the county’s Health Services Department did indeed become a “certified enrollment entity” ahead of the Oct. 1 opening, it is still waiting on Covered California to certify many individual counselors. As a result, some citizens seeking in-person assistance to enroll have had to wait for weeks.
Rachel Kelley, a Stanford postgraduate student who is doing a fellowship with the county’s Health Coverage Unit, said San Mateo went through the certification process “as soon as [it] could.” She partly blames delays in certifying counselors on last month’s federal government shutdown, “which meant that background checks took longer than they should have.”
Larry Hicks, an information officer with Covered California, said he is unaware of a link between the shutdown and any slowdown with in-person consultations. Both Hicks and Kelley indicated that the timetable for becoming a certified enrollment counselor depends on when an individual submits his or her materials to Covered California.
On Thursday, officials announced that the state is on track to reach enrollment goals, with 131,000 people having signed up for private health insurance or Medicaid since Oct. 1. Still, a tiny fraction of uninsured Californians have signed up through Covered California so far.
The state’s website has not experienced the technical problems that continue to plague the federal government’s HealthCare.gov site, but delays for in-person consultations are creating – on a dramatically smaller scale — an obstacle to health care enrollment.
Three days of training
Covered California began to certify enrollment entities over the summer, when an estimated 50 community-based organizations underwent a three-day training process, Hicks said. These organizations, already working in health outreach and education, were provided with federal grants to contract 200 community-based groups, some of which have made the transition to enrollment entities, he said.
Once an organization is certified as an enrollment entity, its members can become enrollment counselors. Certification entails participating in two and a half days of training, taking a competency exam, and undergoing a background check. It all should take about two to three weeks, according to Hicks.
Covered California has “more than 1,000 counselors…[with] 4,400 that are still in various stages of the certification process,” Hicks said. “By the end of this month and certainly before December 15, we’ll have close to 3,000.”
Rayna Lehman, director of AFL-CIO Community Services and San Mateo Central Labor Council, thinks Covered California could have more efficient.
“A problem that is impacting us here had its root in the fact that the state didn’t open up the training soon enough,” she said. “Therefore, it’s taking a long time to get navigators and enrollment assisters trained and ready.”
San Mateo County initially put in a proposal to Covered California to work with “five or six agencies” to receive funding for health care outreach and education, Lehman said, based on the county’s “experience working collectively.”
Instead, Covered California distributed grants to organizations with multiple county jurisdictions. Some of these organizations have been involved with health enrollment in the past, but others have not.
A $58 incentive
The shortage of counselors is, in part, due to the reluctance of smaller organizations to become certified enrollment entities. Although the Covered California website lists nonprofits and labor organizations as possible enrollment entities, the $58 compensation per successful enrollment is not enough of a financial motivation for smaller organizations like Lehman’s.
“Getting paid 58 bucks for each successful enrollment is not going to pay someone’s salary for a week,” she said.
Lehman pointed out that Covered California made its official website and calling center the high-priority outreach options.
Hicks did not dispute that.
“We didn’t promise that there would be a certain number [of enrollment counselors] at certain locations at a certain date.”
“It was important that we get [the website] up and running,” he said, adding that “you can call someone probably [more easily] than jump in your car to talk to certified entities.”
The website has had 2.5 million unique visits since Oct. 1 and the calling center received 250,000 calls in October, according to Hicks.
Lehman believes the state’s focus on the Covered California website is motivated by its goal to enroll “young invincibles who can use a computer easily.”
“That’s the group you want in an insurance pool, because they are the healthy folks that help reduce the risk pool,” she said.
However, many Californians lack easy access to computers, including low-income and elderly residents. In addition, in-person enrollment counselors often are relied upon to help people navigate complicated circumstances. For example, San Mateo County is home to a sizeable number of mixed status families – parents may be undocumented immigrants and therefore be ineligible for coverage while their children are U.S. born and able to be insured.
Hicks explained that Covered California has “accelerated” the process and is certifying about 200 enrollment counselors per week. During the week of Oct. 27 to Nov. 2, Covered California had 828 enrollment counselors. This number increased to 1,045 between Nov. 3 and Nov. 9, he said.
Hicks said his colleagues are “very encouraged by the current pace of certification.”
“We didn’t promise that there would be a certain number [of enrollment counselors] at certain locations at a certain date,” he said. “We know that demand is out there and we’re working [with that] demand.”