California will implement the key enrollment expansions of the Patient Protection and Affordable Care Act (ACA) in January 2014, with preenrollment beginning in October 2013.The state will expand Medicaid, known as Medi-Cal in California, to include previously ineligible adults with incomes up to 138 percent of the federal poverty level. It will also launch a Health Insurance Marketplace, known as Covered California. Individuals, families,and small businesses can purchase insurance through Covered California, and those with low and moderate incomes may qualify for tax credits and cost-sharing subsidies. As many as 1.6 million Californians could gain health insurance coverage through the expansion of Medi-Cal. Approximately 2.6 million Californians are expected to qualify for credits or subsidies through Covered California, and another 2.7 million could enroll and benefit from guaranteed coverage.
California is creating a new, statewide enrollment system to support this historic coverage expansion. The system, known as the California Healthcare Eligibility, Enrollment, and Retention System or CalHEERS, must accommodate consumer needs and preferences for ease, convenience, and assistance. The system must also enable the state to efficiently process an anticipated influx of applications and promptly notify consumers of their eligibility. Self-service online applications, required by the ACA, are one promising way to meet the dual goal of consumer friendliness and system efficiency. They could be an important source of applications for coverage.
California has experience with self-service online enrollment, most notably through the statewide Health-e-App Public Access (HeA PA) system. HeA PA was introduced in December 2010 for Healthy Families, California's Children's Health Insurance Program (CHIP), and now is used for Medi-Cal for Families. Applicants can access HeA PA wherever and whenever they use the Internet. Available in English and Spanish, HeA PA automatically checks for errors and omissions and directs applicants only to questions that apply to them. The fully automated HeA PA eliminates most manual data entry and reduces the time that application processors spend pursuing complete or correct information from applicants.
Mathematica Policy Research, Inc. has studied the first year of HeA PA implementation and presented findings in four research briefs. Although the circumstances surrounding the launch of HeA PA were quite different from the eligibility expansion, enrollment-system change, and mass outreach now under way in California, key findings from the HeA PA study have implications for ACA implementation in California and other states. HeA PA contributed to growth in program applications, was used and well received by a segment of Internet-connected applicants, and complemented the system of assisted-online applications that many applicants used. Each page of this final brief presents a key study finding and potential implications.