California Wants to Cap Medical Bills, but the Health Care Industry Pushes Back
Covered California's Enrollment Deadline Now Extended to Feb. 9
Layoffs: From Unemployment Benefits to Health Insurance, the Steps to Take ASAP
New California Law Bans Surprise Ambulance Bills That Can Put Families in Debt
How to Get Reimbursed for At-Home COVID Tests This Winter
What to Do if You're One of the Thousands of Californians Losing Medi-Cal Coverage Every Month
'It's Worrisome': Covered California Announces Biggest Increase in Premiums
For Many Long COVID Patients, Qualifying for Disability Is Half the Battle
Lawmakers, Newsom Squabble Over Promise to Lower Costs of Covered California
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But, over time, experts say the cap on price increases could make a difference in how much Californians pay for health care.\u003c/p>\n\u003cp>“A 3.0% target places California on the path of a more sustainable, affordable and equitable health care system, slowing the trajectory of growth and improving affordability for all,” the office wrote in its recommendation.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Office of Health Care Affordability\"]‘A 3.0% target places California on the path of a more sustainable, affordable and equitable health care system, slowing the trajectory of growth and improving affordability for all.’[/pullquote]The agency’s announcement immediately drew criticism from health care industry representatives who called it “unrealistic” and “arbitrary.” They contend it could harm patients by reducing access to care if health providers are watching their spending reduce services.\u003c/p>\n\u003cp>Meanwhile, consumer advocates and health economists characterized it as a good first step in the state’s effort to control costs.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/health/2022/07/rising-health-care-costs/\">Gov. Gavin Newsom established the office\u003c/a> through a provision in the 2022 state budget. Its job is to collect health expenditure data from providers and insurers, analyze it and set limits on spending for the industry.\u003c/p>\n\u003cp>\u003ca href=\"https://www.chcf.org/publication/cost-commissions-eight-states-address-cost-growth/\">Eight other states\u003c/a> have cost benchmarks. At 3%, California’s would be one of the more stringent caps — third only to Connecticut and Nevada.\u003c/p>\n\u003cp>California’s proposed target would allow health care prices and spending to increase but slower than in recent years. Between 2015 and 2020, per capita health spending grew each year by an average of 5.2%, outpacing wages, according to the Office of Health Care Affordability.\u003c/p>\n\u003cp>Health spending in California reached $405 billion in 2020 — that’s $10,299 per person, according to federal data. This includes what private insurers, public programs and individuals pay for direct services and goods, such as hospital and physician care, prescription drugs and medical devices. It does not include the administrative costs of insurance or public health funding.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The office plans to roll out one statewide cap but may eventually create regional and sector-specific targets. Officials said they came up with the 3% figure because that is how much the annual median household income has changed over the last 20 years.\u003c/p>\n\u003cp>“Most importantly, tying to historical median household income growth signals that health care spending should not grow faster than the income of California families,” Vishaal Pegany, deputy director of the Office of Health Care Affordability, said during the most recent board meeting.\u003c/p>\n\u003cp>Providers and entities that fail to meet the proposed benchmark could have to make improvements or face financial penalties. They would not be punished in the program’s first year.\u003c/p>\n\u003cp>The \u003ca href=\"https://hcai.ca.gov/public-meetings/february-health-care-affordability-board-meeting/\">state’s health care affordability board\u003c/a> is scheduled to continue discussions this month and has until June 1 to approve a cost target that would go into effect in 2025 and last through 2029.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://e.infogram.com/d62c39a9-a90d-491d-a17f-680523ba32ad?parent_url=https%3A%2F%2Fcalmatters.org%2Fhealth%2F2024%2F02%2Fhealth-care-costs-cap%2F&src=embed#async_embed\" width=\"800\" height=\"730\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003ch2>No instant savings on health care costs\u003c/h2>\n\u003cp>Many Californians are struggling with health care costs. \u003ca href=\"https://www.chcf.org/blog/top-takeaways-california-health-policy-poll/#:~:text=Meanwhile%2C%20close%20to%204%20in,racial%20equity%20in%20health%20care.\">Four in 10 Californians have medical debt\u003c/a>, according to the California Health Care Foundation.\u003c/p>\n\u003cp>Data show that people are spending more of their income on health care. A recently published \u003ca href=\"https://laborcenter.berkeley.edu/wp-content/uploads/2024/01/Measuring-Consumer-Affordability-final.pdf\">study by the UC Berkeley Labor Center (PDF)\u003c/a> found that costs like deductibles are becoming more common. In 2002, 33% of private sector workers enrolled in coverage through their jobs had a deductible. By 2022, 77% of workers did.\u003c/p>\n\u003cp>[aside label=\"Related Stories\" postID=\"news_11974310,news_11970414,news_11949192\"]The size of those deductibles has grown exponentially. Between 2002 and 2022, deductibles for a single-person plan grew 380% or an average of 8.7% every year, researchers found. Deductibles for family plans grew 332% or 7.8% annually.\u003c/p>\n\u003cp>Consumers will probably not feel a difference immediately because the state’s plan is to slow the growth of health spending and not necessarily reduce it.\u003c/p>\n\u003cp>But over time, it could make a difference. Glenn Melnick, a health economist at the University of Southern California, gives this example: “If I have to pay 25% of my (health insurance) premium, let’s say I get it from work, if my premium goes up more slowly, my contribution will be less.”\u003c/p>\n\u003cp>“What if this target had been in place for the last 10 years?” he said.\u003c/p>\n\u003ch2>California providers criticize cap\u003c/h2>\n\u003cp>Representatives for hospitals and doctors caution that basing the spending cap solely on household income rather than taking into account what it costs them to provide care could result in less access and poorer quality of care for patients.\u003c/p>\n\u003cp>They argue the proposed cap doesn’t take into account things providers have no control over, such as general inflation, rising pharmaceutical costs and natural increases in spending driven by the state’s aging population.\u003c/p>\n\u003cp>“[The office’s] proposed target entirely ignores the drivers of health care spending. In doing so, it would force health care providers to significantly cut back on the care they provide or face penalties,” wrote Ben Johnson, vice president of policy at the California Hospital Association, in a letter to the board.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Ben Johnson, vice president of policy, California Hospital Association\"]‘[The office’s] proposed target entirely ignores the drivers of health care spending. In doing so, it would force health care providers to significantly cut back on the care they provide or face penalties.’[/pullquote]Some industry representatives noted specific access issues, such as narrow provider networks and long wait times, are already a top concern for the public. “A 3% target put in place for five years seems likely to result in wait times increasing,” Janice Rocco, chief of staff at the California Medical Association, said during the board’s recent meeting.\u003c/p>\n\u003cp>Dr. Richard Pan, a Sacramento pediatrician and former state senator who sits on the health care affordability board, said that for the state’s plan to truly work, the office and board would have to nail down the methodology behind the spending target so that the industry groups have confidence in it.\u003c/p>\n\u003cp>“We still have some time; these things need to be thought out,” Pan said. “Not everyone has to agree, but it has to be credible to the people that have to implement it.”\u003c/p>\n\u003cp>Melnick of USC said the industry’s argument that a cost-growth target would harm health access and quality is already an issue with today’s spending levels.\u003c/p>\n\u003cp>“A lot of people put off care because they can’t afford it,” he said. “That’s an access and quality impact.”\u003c/p>\n\u003cp>\u003cem>Supported by the California Health Care Foundation (CHCF), which works to ensure that\u003c/em> \u003cem>people have access to the care they need, when they need it, at a price they can afford. Visit \u003c/em>\u003ca href=\"http://www.chcf.org/\">\u003cem>www.chcf.org\u003c/em>\u003c/a>\u003cem> to learn more.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"California’s new Office of Health Care Affordability has a mandate to control price increases and is proposing a 3% cost-increase target that’s among the most aggressive in America. ","status":"publish","parent":0,"modified":1707528174,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":true,"iframeSrcs":["https://e.infogram.com/d62c39a9-a90d-491d-a17f-680523ba32ad"],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":31,"wordCount":1231},"headData":{"title":"California Wants to Cap Medical Bills, but the Health Care Industry Pushes Back | KQED","description":"California’s new Office of Health Care Affordability has a mandate to control price increases and is proposing a 3% cost-increase target that’s among the most aggressive in America. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"sticky":false,"nprByline":"\u003ca href=\"https://calmatters.org/author/anaibarra/\">Ana B. Ibarra\u003c/a>","excludeFromSiteSearch":"Include","showOnAuthorArchivePages":"No","articleAge":"0","path":"/news/11975284/california-sets-ambitious-goal-to-cap-medical-bills-but-the-health-care-industry-is-pushing-back","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>A new state office charged with controlling the rising cost of health care in California is moving toward one of the most aggressive goals in the nation, aiming to cap cost increases to 3% a year.\u003c/p>\n\u003cp>You might not notice immediately if the Office of Health Care Affordability commits to the tentative goal it released last month and takes steps to enforce it. But, over time, experts say the cap on price increases could make a difference in how much Californians pay for health care.\u003c/p>\n\u003cp>“A 3.0% target places California on the path of a more sustainable, affordable and equitable health care system, slowing the trajectory of growth and improving affordability for all,” the office wrote in its recommendation.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘A 3.0% target places California on the path of a more sustainable, affordable and equitable health care system, slowing the trajectory of growth and improving affordability for all.’","name":"pullquote","attributes":{"named":{"align":"right","size":"medium","citation":"Office of Health Care Affordability","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>The agency’s announcement immediately drew criticism from health care industry representatives who called it “unrealistic” and “arbitrary.” They contend it could harm patients by reducing access to care if health providers are watching their spending reduce services.\u003c/p>\n\u003cp>Meanwhile, consumer advocates and health economists characterized it as a good first step in the state’s effort to control costs.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/health/2022/07/rising-health-care-costs/\">Gov. Gavin Newsom established the office\u003c/a> through a provision in the 2022 state budget. Its job is to collect health expenditure data from providers and insurers, analyze it and set limits on spending for the industry.\u003c/p>\n\u003cp>\u003ca href=\"https://www.chcf.org/publication/cost-commissions-eight-states-address-cost-growth/\">Eight other states\u003c/a> have cost benchmarks. At 3%, California’s would be one of the more stringent caps — third only to Connecticut and Nevada.\u003c/p>\n\u003cp>California’s proposed target would allow health care prices and spending to increase but slower than in recent years. Between 2015 and 2020, per capita health spending grew each year by an average of 5.2%, outpacing wages, according to the Office of Health Care Affordability.\u003c/p>\n\u003cp>Health spending in California reached $405 billion in 2020 — that’s $10,299 per person, according to federal data. This includes what private insurers, public programs and individuals pay for direct services and goods, such as hospital and physician care, prescription drugs and medical devices. It does not include the administrative costs of insurance or public health funding.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The office plans to roll out one statewide cap but may eventually create regional and sector-specific targets. Officials said they came up with the 3% figure because that is how much the annual median household income has changed over the last 20 years.\u003c/p>\n\u003cp>“Most importantly, tying to historical median household income growth signals that health care spending should not grow faster than the income of California families,” Vishaal Pegany, deputy director of the Office of Health Care Affordability, said during the most recent board meeting.\u003c/p>\n\u003cp>Providers and entities that fail to meet the proposed benchmark could have to make improvements or face financial penalties. They would not be punished in the program’s first year.\u003c/p>\n\u003cp>The \u003ca href=\"https://hcai.ca.gov/public-meetings/february-health-care-affordability-board-meeting/\">state’s health care affordability board\u003c/a> is scheduled to continue discussions this month and has until June 1 to approve a cost target that would go into effect in 2025 and last through 2029.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://e.infogram.com/d62c39a9-a90d-491d-a17f-680523ba32ad?parent_url=https%3A%2F%2Fcalmatters.org%2Fhealth%2F2024%2F02%2Fhealth-care-costs-cap%2F&src=embed#async_embed\" width=\"800\" height=\"730\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003ch2>No instant savings on health care costs\u003c/h2>\n\u003cp>Many Californians are struggling with health care costs. \u003ca href=\"https://www.chcf.org/blog/top-takeaways-california-health-policy-poll/#:~:text=Meanwhile%2C%20close%20to%204%20in,racial%20equity%20in%20health%20care.\">Four in 10 Californians have medical debt\u003c/a>, according to the California Health Care Foundation.\u003c/p>\n\u003cp>Data show that people are spending more of their income on health care. A recently published \u003ca href=\"https://laborcenter.berkeley.edu/wp-content/uploads/2024/01/Measuring-Consumer-Affordability-final.pdf\">study by the UC Berkeley Labor Center (PDF)\u003c/a> found that costs like deductibles are becoming more common. In 2002, 33% of private sector workers enrolled in coverage through their jobs had a deductible. By 2022, 77% of workers did.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"label":"Related Stories ","postid":"news_11974310,news_11970414,news_11949192"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>The size of those deductibles has grown exponentially. Between 2002 and 2022, deductibles for a single-person plan grew 380% or an average of 8.7% every year, researchers found. Deductibles for family plans grew 332% or 7.8% annually.\u003c/p>\n\u003cp>Consumers will probably not feel a difference immediately because the state’s plan is to slow the growth of health spending and not necessarily reduce it.\u003c/p>\n\u003cp>But over time, it could make a difference. Glenn Melnick, a health economist at the University of Southern California, gives this example: “If I have to pay 25% of my (health insurance) premium, let’s say I get it from work, if my premium goes up more slowly, my contribution will be less.”\u003c/p>\n\u003cp>“What if this target had been in place for the last 10 years?” he said.\u003c/p>\n\u003ch2>California providers criticize cap\u003c/h2>\n\u003cp>Representatives for hospitals and doctors caution that basing the spending cap solely on household income rather than taking into account what it costs them to provide care could result in less access and poorer quality of care for patients.\u003c/p>\n\u003cp>They argue the proposed cap doesn’t take into account things providers have no control over, such as general inflation, rising pharmaceutical costs and natural increases in spending driven by the state’s aging population.\u003c/p>\n\u003cp>“[The office’s] proposed target entirely ignores the drivers of health care spending. In doing so, it would force health care providers to significantly cut back on the care they provide or face penalties,” wrote Ben Johnson, vice president of policy at the California Hospital Association, in a letter to the board.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘[The office’s] proposed target entirely ignores the drivers of health care spending. In doing so, it would force health care providers to significantly cut back on the care they provide or face penalties.’","name":"pullquote","attributes":{"named":{"align":"right","size":"medium","citation":"Ben Johnson, vice president of policy, California Hospital Association","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Some industry representatives noted specific access issues, such as narrow provider networks and long wait times, are already a top concern for the public. “A 3% target put in place for five years seems likely to result in wait times increasing,” Janice Rocco, chief of staff at the California Medical Association, said during the board’s recent meeting.\u003c/p>\n\u003cp>Dr. Richard Pan, a Sacramento pediatrician and former state senator who sits on the health care affordability board, said that for the state’s plan to truly work, the office and board would have to nail down the methodology behind the spending target so that the industry groups have confidence in it.\u003c/p>\n\u003cp>“We still have some time; these things need to be thought out,” Pan said. “Not everyone has to agree, but it has to be credible to the people that have to implement it.”\u003c/p>\n\u003cp>Melnick of USC said the industry’s argument that a cost-growth target would harm health access and quality is already an issue with today’s spending levels.\u003c/p>\n\u003cp>“A lot of people put off care because they can’t afford it,” he said. “That’s an access and quality impact.”\u003c/p>\n\u003cp>\u003cem>Supported by the California Health Care Foundation (CHCF), which works to ensure that\u003c/em> \u003cem>people have access to the care they need, when they need it, at a price they can afford. Visit \u003c/em>\u003ca href=\"http://www.chcf.org/\">\u003cem>www.chcf.org\u003c/em>\u003c/a>\u003cem> to learn more.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11975284/california-sets-ambitious-goal-to-cap-medical-bills-but-the-health-care-industry-is-pushing-back","authors":["byline_news_11975284"],"categories":["news_457","news_8"],"tags":["news_27626","news_25015","news_683","news_1054"],"affiliates":["news_18481"],"featImg":"news_11975288","label":"news_18481"},"news_11974310":{"type":"posts","id":"news_11974310","meta":{"index":"posts_1591205157","site":"news","id":"11974310","score":null,"sort":[1706742489000]},"guestAuthors":[],"slug":"covered-californias-enrollment-deadline-now-extended-to-feb-9","title":"Covered California's Enrollment Deadline Now Extended to Feb. 9","publishDate":1706742489,"format":"standard","headTitle":"Covered California’s Enrollment Deadline Now Extended to Feb. 9 | KQED","labelTerm":{"site":"news"},"content":"\u003cp>The deadline to enroll in a health care plan through Covered California — \u003ca href=\"https://www.coveredca.com/\">the state’s health insurance marketplace that offers hundreds of low-cost coverage plans\u003c/a> — has been extended until Friday, Feb. 9.\u003c/p>\n\u003cp>Previously, the deadline to sign up for a plan was Wednesday, Jan. 31.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Jessica Altman, executive director, Covered California\"]‘We want any Californian who needs health insurance to have the opportunity to get covered for the rest of 2024, and extending the open-enrollment period will ensure they have the time they need.’[/pullquote]State officials made the announcement \u003ca href=\"https://www.coveredca.com/newsroom/news-releases/2024/01/31/\">through a press release on Wednesday\u003c/a>, explaining that Covered California’s service center was recently taken offline in response to a cybersecurity incident that affected the third-party vendor that supports its phone lines. Many residents who tried to sign up for a health care plan by calling the service center experienced long wait times, the release said, which also noted that “at this time,” there was no indication that any members’ personal information was compromised.\u003c/p>\n\u003cp>“We want any Californian who needs health insurance to have the opportunity to get covered for the rest of 2024, and extending the open-enrollment period will ensure they have the time they need,” Covered California Executive Director Jessica Altman said.\u003c/p>\n\u003ch2>Ways to sign up\u003c/h2>\n\u003cp>Consumers have several ways to find a health care plan — not just over the phone. One option is visiting Covered California’s website at \u003ca href=\"https://www.coveredca.com/\">coveredca.com\u003c/a>.\u003c/p>\n\u003cp>If your job doesn’t provide health insurance and you don’t qualify for Medi-Cal, you may be eligible for a Covered California plan. Thanks to a mix of federal and state subsidies, many plans offer monthly premiums under $30.\u003c/p>\n\u003cp>If you are undocumented, you can also look for an insurance plan through Covered California — but you’ll have to meet the income requirements for Medi-Cal.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>California is one of two states \u003ca href=\"https://www.coveredca.com/learning-center/tax-penalty-details-and-exemptions/penalty/\">that requires residents to pay a penalty if uninsured\u003c/a>. The penalty for not having coverage the entire year would be at least $900 per adult when you file taxes this year. If you have a child under 18 that is dependent on you, that’s an additional $450 per kid.\u003c/p>\n\u003ch2>An increase in enrollment\u003c/h2>\n\u003cp>More than 243,000 people have already signed up this enrollment period, state officials said — \u003ca href=\"https://www.coveredca.com/newsroom/news-releases/2024/01/25/end-of-oe/\">a 13% increase from last year\u003c/a>. California already boasts one of the lowest uninsured rates in the country, with only 6.2% of non-elderly Californians lacking health insurance, \u003ca href=\"https://www.chcf.org/publication/california-achieves-lowest-uninsured-rate-ever-2022/\">according to a 2023 report from the California Health Care Foundation\u003c/a>. When the state launched its insurance marketplace in 2013, \u003ca href=\"https://calbudgetcenter.org/resources/continuing-the-path-towards-universal-health-coverage-in-california/#:~:text=The%20percentage%20of%20Californians%20without,uninsured%20rate%20was%20over%2017%25.\">the uninsured rate was around 17%\u003c/a>.\u003c/p>\n\u003cp>[aside label=\"Related Stories\" postID=\"news_11949192,news_11956545,news_11961980\"]The nation’s top health official, United States Health and Human Services Secretary Xavier Becerra, visited San Francisco on Tuesday to mark these new figures, and offered uninsured Californians a last push of encouragement to apply to Covered California (before the deadline extension was then announced on Wednesday).\u003c/p>\n\u003cp>“My mother would always say, \u003cem>mejor prevenir que remediar\u003c/em> — better to prevent than to remediate an illness,” Becerra said. “Health care insurance helps you prevent your children from becoming ill. If you don’t have insurance, you wait till they’re so ill they have to go to the hospital.”\u003c/p>\n\u003cp>At the national level, 21.3 million people nationwide enrolled in a health care plan this year through the Affordable Care Act (ACA) marketplaces. Many are receiving subsidies for their plans owing to the Inflation Reduction Act that Congress passed in 2022, and Becerra said he hoped Congress would vote to keep those subsidies in place.\u003c/p>\n\u003cp>Despite multiple attempts by Congressional Republicans each year to repeal ACA — also known as Obamacare — marketplaces have only grown since the health care law passed in 2010. “There was talk that when the Affordable Care Act launched, insurers would not buy in because it wouldn’t be a profitable enterprise for them,” Becerra said.\u003c/p>\n\u003cp>“Well, they’re in. Now what’s happening is they’re offering a panoply of plans; it’s tough to figure out which one is good for you,” he added.\u003c/p>\n\u003cp>“So we’re going to move more towards requiring the plans [to] provide some standardization, so people can make some good guesses about what might be good for them,” Becerra said.\u003c/p>\n\u003cp>\u003c/p>\n","blocks":[],"excerpt":"The deadline for Covered California health care enrollment was extended to give Californians 'the time they need,' Covered California Executive Director Jessica Altman said.","status":"publish","parent":0,"modified":1706742489,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":17,"wordCount":764},"headData":{"title":"Covered California's Enrollment Deadline Now Extended to Feb. 9 | KQED","description":"The deadline for Covered California health care enrollment was extended to give Californians 'the time they need,' Covered California Executive Director Jessica Altman said.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"sticky":false,"excludeFromSiteSearch":"Include","articleAge":"0","path":"/news/11974310/covered-californias-enrollment-deadline-now-extended-to-feb-9","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The deadline to enroll in a health care plan through Covered California — \u003ca href=\"https://www.coveredca.com/\">the state’s health insurance marketplace that offers hundreds of low-cost coverage plans\u003c/a> — has been extended until Friday, Feb. 9.\u003c/p>\n\u003cp>Previously, the deadline to sign up for a plan was Wednesday, Jan. 31.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘We want any Californian who needs health insurance to have the opportunity to get covered for the rest of 2024, and extending the open-enrollment period will ensure they have the time they need.’","name":"pullquote","attributes":{"named":{"align":"right","size":"medium","citation":"Jessica Altman, executive director, Covered California","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>State officials made the announcement \u003ca href=\"https://www.coveredca.com/newsroom/news-releases/2024/01/31/\">through a press release on Wednesday\u003c/a>, explaining that Covered California’s service center was recently taken offline in response to a cybersecurity incident that affected the third-party vendor that supports its phone lines. Many residents who tried to sign up for a health care plan by calling the service center experienced long wait times, the release said, which also noted that “at this time,” there was no indication that any members’ personal information was compromised.\u003c/p>\n\u003cp>“We want any Californian who needs health insurance to have the opportunity to get covered for the rest of 2024, and extending the open-enrollment period will ensure they have the time they need,” Covered California Executive Director Jessica Altman said.\u003c/p>\n\u003ch2>Ways to sign up\u003c/h2>\n\u003cp>Consumers have several ways to find a health care plan — not just over the phone. One option is visiting Covered California’s website at \u003ca href=\"https://www.coveredca.com/\">coveredca.com\u003c/a>.\u003c/p>\n\u003cp>If your job doesn’t provide health insurance and you don’t qualify for Medi-Cal, you may be eligible for a Covered California plan. Thanks to a mix of federal and state subsidies, many plans offer monthly premiums under $30.\u003c/p>\n\u003cp>If you are undocumented, you can also look for an insurance plan through Covered California — but you’ll have to meet the income requirements for Medi-Cal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California is one of two states \u003ca href=\"https://www.coveredca.com/learning-center/tax-penalty-details-and-exemptions/penalty/\">that requires residents to pay a penalty if uninsured\u003c/a>. The penalty for not having coverage the entire year would be at least $900 per adult when you file taxes this year. If you have a child under 18 that is dependent on you, that’s an additional $450 per kid.\u003c/p>\n\u003ch2>An increase in enrollment\u003c/h2>\n\u003cp>More than 243,000 people have already signed up this enrollment period, state officials said — \u003ca href=\"https://www.coveredca.com/newsroom/news-releases/2024/01/25/end-of-oe/\">a 13% increase from last year\u003c/a>. California already boasts one of the lowest uninsured rates in the country, with only 6.2% of non-elderly Californians lacking health insurance, \u003ca href=\"https://www.chcf.org/publication/california-achieves-lowest-uninsured-rate-ever-2022/\">according to a 2023 report from the California Health Care Foundation\u003c/a>. When the state launched its insurance marketplace in 2013, \u003ca href=\"https://calbudgetcenter.org/resources/continuing-the-path-towards-universal-health-coverage-in-california/#:~:text=The%20percentage%20of%20Californians%20without,uninsured%20rate%20was%20over%2017%25.\">the uninsured rate was around 17%\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"label":"Related Stories ","postid":"news_11949192,news_11956545,news_11961980"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>The nation’s top health official, United States Health and Human Services Secretary Xavier Becerra, visited San Francisco on Tuesday to mark these new figures, and offered uninsured Californians a last push of encouragement to apply to Covered California (before the deadline extension was then announced on Wednesday).\u003c/p>\n\u003cp>“My mother would always say, \u003cem>mejor prevenir que remediar\u003c/em> — better to prevent than to remediate an illness,” Becerra said. “Health care insurance helps you prevent your children from becoming ill. If you don’t have insurance, you wait till they’re so ill they have to go to the hospital.”\u003c/p>\n\u003cp>At the national level, 21.3 million people nationwide enrolled in a health care plan this year through the Affordable Care Act (ACA) marketplaces. Many are receiving subsidies for their plans owing to the Inflation Reduction Act that Congress passed in 2022, and Becerra said he hoped Congress would vote to keep those subsidies in place.\u003c/p>\n\u003cp>Despite multiple attempts by Congressional Republicans each year to repeal ACA — also known as Obamacare — marketplaces have only grown since the health care law passed in 2010. “There was talk that when the Affordable Care Act launched, insurers would not buy in because it wouldn’t be a profitable enterprise for them,” Becerra said.\u003c/p>\n\u003cp>“Well, they’re in. Now what’s happening is they’re offering a panoply of plans; it’s tough to figure out which one is good for you,” he added.\u003c/p>\n\u003cp>“So we’re going to move more towards requiring the plans [to] provide some standardization, so people can make some good guesses about what might be good for them,” Becerra said.\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11974310/covered-californias-enrollment-deadline-now-extended-to-feb-9","authors":["11708"],"categories":["news_457","news_8"],"tags":["news_5164","news_27626","news_683","news_1054"],"featImg":"news_11974380","label":"news"},"news_11949192":{"type":"posts","id":"news_11949192","meta":{"index":"posts_1591205157","site":"news","id":"11949192","score":null,"sort":[1705007435000]},"guestAuthors":[],"slug":"layoffs-unemployment-benefits-health-insurance-calfresh","title":"Layoffs: From Unemployment Benefits to Health Insurance, the Steps to Take ASAP","publishDate":1705007435,"format":"standard","headTitle":"Layoffs: From Unemployment Benefits to Health Insurance, the Steps to Take ASAP | KQED","labelTerm":{"site":"news"},"content":"\u003cp>\u003cem>This guide is part of the KQED News series \u003cstrong>\u003ca href=\"https://www.kqed.org/news/tag/what-to-do-after-a-layoff\">What to Do After a Layoff.\u003c/a>\u003c/strong>\u003c/em>\u003c/p>\n\u003cp>Knowing what to do when you get laid off can feel like a daunting prospect — especially if losing your job came as a total shock.\u003c/p>\n\u003cp>We’ve compiled a list of the initial steps to take after a layoff, to ensure you’re in as secure a place as possible. Jump straight to:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"#unemploymentbenefits\">Applying for unemployment benefits\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#healthinsurance\">Keeping your health insurance\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#otherbenefits\">Other benefits you might not know you’re eligible for\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003cp>… Or keep reading. As with the instructions for assembling furniture, you might find it helpful to read all this advice start to finish before you embark on these applications — to be prepared for any bumps you might encounter.\u003c/p>\n\u003ch2>Three tips to making applying for benefits after a layoff easier\u003c/h2>\n\u003cp>\u003cb>Your local government may have staff to help you do this\u003c/b>\u003c/p>\n\u003cp>Many cities and counties have their own offices, staff or programs specifically designed for people in your situation right now — which often have physical offices you can visit, or hotlines to call to ask a person your questions. These kinds of local resources can be particularly helpful in navigating the various benefits you could be entitled to, and aiding in the application processes.\u003c/p>\n\u003cp>Some offices, like the Department of Benefits and Family Support within \u003ca href=\"https://www.sfhsa.org/\">San Francisco’s Human Services Agency (SFHSA)\u003c/a>, can take your information in one central application and apply for those benefits on your behalf.\u003c/p>\n\u003cp>Having the help of a city staffer trained in these applications could save you a lot of time and stress, says Bart Ellison, program manager at SFHSA’s Workforce Development Division — not just because the process is streamlined, but because you’ll be able to ask these folks questions either in person or over the phone. It’s their job to help you — let them do it.\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"#tellus\">Tell us: What else do you need information about right now?\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003cp>Your city or county may also have a program to help you find new employment, like \u003ca href=\"https://www.sfhsa.org/services/jobs/jobsnow\">SFHSA’s free JobsNOW! program\u003c/a>, which is open to San Francisco job seekers based on their income level, and matches job hunters with roles.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdss.ca.gov/county-offices\">Find your local social services office in this statewide list.\u003c/a>\u003c/p>\n\u003cp>\u003cb>Don’t feel weird about claiming the benefits you’re owed\u003c/b>\u003c/p>\n\u003cp>When it comes to claiming benefits after a layoff, Ellison wants to remind you that “we all pay for this through our taxes.”\u003c/p>\n\u003cp>“It’s great that if you don’t need it, it’s there. If you do need it, it’s there, and it should be accessed,” Ellison said. “There’s no shame in any of that.”\u003c/p>\n\u003cp>[aside postID=\"news_11957790,news_11970001,news_11967946,news_11968709\" label=\"COVID Resources and Explainers\"]A lot of people also just don’t know about the benefits they could be eligible for, says Ellison, or assume they won’t qualify.\u003c/p>\n\u003cp>He also says that some of the eligible job seekers he and his team work with in San Francisco might fear coming forward to apply if a member of their family is undocumented, because they think it will cause them problems. “We don’t get involved in any of that,” said Ellison. “They should never fear that situation.”\u003c/p>\n\u003cp>\u003cb>Try to be patient with how long the application process could take\u003c/b>\u003c/p>\n\u003cp>Ellison says he and his team “try not to ask a client for documents that we know we already have in the system” — but concedes that sometimes, this process will feel like providing endless documentation. The benefits you’re applying for can be a mix of federal and state funds, so unfortunately “it’s not just as simple as coming in and saying, ‘Hi, I’m Bart, could you sign me up?,’” said Ellison.\u003c/p>\n\u003cp>The more you can follow through with any documentation requests, hopefully the faster and smoother your application process will go. “And if you need more time or need help gathering stuff, that is what the eligibility staff are there for,” said Ellison. “They are there to \u003ci>help \u003c/i>you find some of these things. So you just need to kind of be your own advocate, and speak up.”\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Read more layoff advice in our \u003ca href=\"https://www.kqed.org/news/tag/what-to-do-after-a-layoff\">What to Do After a Layoff \u003c/a>series\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003ch2>\u003ca id=\"unemploymentbenefits\">\u003c/a>Step 1: Apply for unemployment benefits\u003c/h2>\n\u003cp>If you’ve been laid off, \u003ca href=\"https://edd.ca.gov/en/unemployment/apply/\">apply for unemployment insurance\u003c/a> (UI, also known just as “unemployment”) from the California Employment Development Department (EDD) as soon as you can. Not only could it take at least three weeks to receive any benefits payments from a successful claim, but your claim begins when you first apply for it — not the day you lose your job. So time is of the essence.\u003c/p>\n\u003cp>\u003cb>Who can claim unemployment benefits?\u003c/b>\u003c/p>\n\u003cp>If you’re reading this and you \u003ci>chose\u003c/i> to leave your job, you usually aren’t eligible to claim unemployment. The exception to this is if you quit your job for what EDD calls “good cause,” which can include unsafe working conditions or a doctor’s advice. Whether or not you’re eligible to still claim UI in this situation will be determined by a phone interview with an EDD representative.\u003c/p>\n\u003cp>When applying for UI, you’ll have to show EDD that you have earned enough wages during the base period of 12 months, are totally or partially unemployed, are “unemployed through no fault of your own,” are physically able to work, are available for work and are ready and willing to accept work immediately.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>EDD will also ask you to show that you are “in satisfactory immigration status and authorized to work in the United States” not only now, but when you were earning the wages you’re using to establish your claim. EDD also warns that it will verify your immigration status and work authorization through the Department of Homeland Security.\u003c/p>\n\u003cp>You can \u003ca href=\"https://edd.ca.gov/en/unemployment/UI-Calculator/\">calculate the amount of unemployment benefits you can receive using this tool\u003c/a>. Remember that the amount of unemployment you’ll receive is based on your wages over the last 18 months, calculated by EDD from a base period of 12 months within that time — and if you didn’t earn any wages during that period, you won’t qualify for unemployment benefits.\u003c/p>\n\u003cp>\u003ca href=\"https://edd.ca.gov/en/unemployment/FAQ_-_Eligibility/\">See the EDD’s FAQ on who’s eligible to claim unemployment insurance.\u003c/a>\u003c/p>\n\u003cp>\u003cb>Gather your application information\u003c/b>\u003c/p>\n\u003cp>During your online application for UI, you’ll be asked to submit a lot of information — and it’s easiest to have all that gathered and ready, rather than trying to track it down in the middle of the process.\u003c/p>\n\u003cp>In addition to your basic identity information, you’ll need:\u003c/p>\n\u003cul>\n\u003cli>Your Social Security number\u003c/li>\n\u003cli>Your employment authorization information, if you’re not a U.S. citizen\u003c/li>\n\u003cli>A photo ID like a passport or driver’s license (for your ID.me account — more below)\u003c/li>\n\u003c/ul>\n\u003cp>You’ll also need to provide your employment history for the last 18 months, which will include:\u003c/p>\n\u003cul>\n\u003cli>The names of your previous employers\u003c/li>\n\u003cli>Their addresses\u003c/li>\n\u003cli>Their phone numbers\u003c/li>\n\u003cli>The reason each job ended\u003c/li>\n\u003cli>Your gross (total) wages earned\u003c/li>\n\u003cli>Hours worked per week\u003c/li>\n\u003cli>Hourly rate of pay\u003c/li>\n\u003c/ul>\n\u003cfigure id=\"attachment_11946480\" class=\"wp-caption alignnone\" style=\"max-width: 2560px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11946480 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/04/GettyImages-1400799758-scaled.jpg\" alt=\"A woman sits at her kitchen table and sifts through documents, looking concerned. Next to her is her opened laptop.\" width=\"2560\" height=\"1708\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/GettyImages-1400799758-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/GettyImages-1400799758-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/GettyImages-1400799758-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/GettyImages-1400799758-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/GettyImages-1400799758-1536x1025.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/GettyImages-1400799758-2048x1366.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/GettyImages-1400799758-1920x1281.jpg 1920w\" sizes=\"(max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">During your online application for UI, you’ll be asked to submit a lot of information — and it’s easiest to have all that gathered and ready, rather than trying to track it down in the middle of the process. \u003ccite>(MoMo Productions/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>Make the online accounts you’ll need to apply \u003c/b>\u003c/p>\n\u003cp>To apply for UI for the first time, you’ll need to \u003ca href=\"https://portal.edd.ca.gov/WebApp/Registration\">create a new Benefit Programs Online account\u003c/a>, to enable you to log in and manage your UI claim. (You may already have one of these accounts if you’ve previously applied for UI, disability insurance or paid family leave — in that case, use the same one.)\u003c/p>\n\u003cp>When you give an email address as part of your Benefit Programs Online application, make sure you check for any emails from EDD. When you get an email with a link to complete your registration, make sure you click that link within 48 hours of receiving it — otherwise, you’ll have to start the registration process all over again.\u003c/p>\n\u003cp>When you’ve created your Benefit Programs Online account, \u003ca href=\"https://edd.ca.gov/en/unemployment/ui_online/\">you’ll then register for UI Online\u003c/a>, which is the part of EDD’s online services that allows you to claim and manage your unemployment benefits. Keep reading for how to file your first UI claim.\u003c/p>\n\u003cp>You’ll \u003ci>also\u003c/i> need to \u003ca href=\"https://help.id.me/hc/en-us/articles/202673924-Creating-your-ID-me-account\">have an account with ID.me\u003c/a>, the identity verification EDD uses to make sure you’re really you when you’re claiming benefits. You can create your ID.me account before you create your Benefit Programs Online account, or when prompted during the process of creating it. If you’re creating your ID.me account beforehand, just make sure you keep the login details on hand so that you can sign into ID.me when prompted.\u003c/p>\n\u003cp>You might consider watching the \u003ca href=\"https://www.youtube.com/watch?v=moJ1mokMRgc\">EDD’s short instructional video on YouTube about creating these accounts and filing your first UI claim\u003c/a>, so you know what to expect during the process.\u003c/p>\n\u003cp>\u003cb>File your new UI claim\u003c/b>\u003c/p>\n\u003cp>One big thing: To start using UI Online, you’ll be asked for your “EDD Customer Account Number.” This is a number that’s unique to you, that you can also give instead of your Social Security number on the phone when speaking with an EDD representative. You should receive this number at the preferred email address you gave to EDD — in which case you can start using that EDD Customer Account Number immediately to register for UI Online. It’s also possible to \u003ca href=\"https://edd.ca.gov/en/unemployment/create-account/\">receive this number via mail “10 days after you file your claim,” says EDD\u003c/a>.\u003c/p>\n\u003cp>To file a new claim, \u003ca href=\"https://portal.edd.ca.gov/WebApp/Login?resource_url=https:%2F%2Fportal.edd.ca.gov%2FWebApp%2FHome\">log into your Benefit Programs Online account\u003c/a>, and under “UI Online” select “File New Claim.” Remember you’ll also be asked to briefly sign in to your ID.me account to verify your identity.\u003c/p>\n\u003cp>You can’t apply with UI Online 24/7, unfortunately — \u003ca href=\"https://edd.ca.gov/en/unemployment/ui_online/\">the site has hours of operation\u003c/a> (located on the File and Manage Account tab), which EDD says are currently (all times Pacific Standard Time):\u003c/p>\n\u003cul>\n\u003cli>Sunday: 5 a.m.–8:30 p.m.\u003c/li>\n\u003cli>Monday: 4 a.m.–10 p.m.\u003c/li>\n\u003cli>Tuesday–Friday: 2 a.m.–10 p.m.\u003c/li>\n\u003cli>Saturday: 2 a.m.–8 p.m.\u003c/li>\n\u003c/ul>\n\u003cp>If you need to pause during the UI Online application process, you can hit “Save as draft” to save your application to return to later — unless it’s \u003ci>after \u003c/i>8 p.m. on the Saturday of the week you’ve started the application. If it’s after 8 p.m. on Saturday, or you’re doing this on a Sunday, you won’t be able to save your application, and you will have to start it all over again if you exit.\u003c/p>\n\u003cp>If you’re having issues with UI Online, \u003ca href=\"https://edd.ca.gov/en/unemployment/ui_online/\">EDD recommends that you call their help line\u003c/a> at (833) 978-2511 and select option 1 after the introduction, available 8 a.m.–5 p.m., Monday through Friday. EDD says that Monday morning before 10 a.m. is their busiest call time.\u003c/p>\n\u003cp>\u003cb>Getting — and keeping — your unemployment benefits\u003c/b>\u003c/p>\n\u003cp>Once your application is complete, be aware of \u003ca href=\"https://edd.ca.gov/en/unemployment/After_You_Filed/\">the next steps and further information that EDD will ask of you\u003c/a>.\u003c/p>\n\u003cp>EDD says that \u003ca href=\"https://edd.ca.gov/en/unemployment/After_You_Filed/\">it “takes at least three weeks to process a claim\u003c/a> for unemployment benefits and issue payment to most eligible workers.” You’ll receive a debit card in the mail, which you can activate and then use to access your payments. If you have an old debit card from a previous UI claim, you can still use that one unless it’s expired (in which case you’ll be sent a new one).\u003c/p>\n\u003cp>To keep receiving UI after you first apply, you’ll have to certify for your unemployment benefits again every two weeks to continue receiving payments. You can do this online, by phone or through the mail, but EDD says you’ll get your payments faster if you certify online — and you’ll also get email reminders this way.\u003c/p>\n\u003cp>As part of this certification process every two weeks, you’ll have to \u003ca href=\"https://www.youtube.com/watch?v=3t_RgeoPH_g\">attest that you’re actively seeking employment\u003c/a>. This requirement was paused during the pandemic, but has since been reinstated. You’ll also need to \u003ca href=\"https://edd.ca.gov/en/jobs_and_training/Caljobs/\">register for CalJOBS and post your resume to the site\u003c/a> to keep receiving your UI benefits.\u003c/p>\n\u003cp>If you start doing any work again after losing your job, it’s very important that you report those earnings when you certify for your UI benefits — because those wages have to be deducted from your unemployment benefits. \u003ca href=\"https://edd.ca.gov/en/unemployment/FAQ-claims/#:~:text=Can%20I%20still%20collect%20benefits,deducted%20from%20your%20unemployment%20payments.\">Read more on how EDD will adjust your UI if you start earning money again while claiming unemployment benefits.\u003c/a>\u003c/p>\n\u003cp>And if you’re lucky enough to find a new full-time job, EDD is clear: “If you return to work full time, you will no longer be eligible for unemployment benefits.”\u003c/p>\n\u003cp>\u003ca href=\"https://edd.ca.gov/en/unemployment/certify/\">See EDD’s FAQ on certifying your UI claim every two weeks.\u003c/a>\u003c/p>\n\u003ch2>\u003ca id=\"healthinsurance\">\u003c/a>Step 2: Address your health insurance\u003c/h2>\n\u003cp>If your health insurance was tied to your employment, you need to act swiftly to ensure you’ll still have access to health care after your job ends. The option that’s best for you after your employment ends will depend primarily on how much income your household will now be receiving after you stop working.\u003c/p>\n\u003cp>Remember that if you’ve applied for unemployment benefits, \u003ca href=\"https://www.healthcare.gov/unemployed/\">you’ll need to declare that unemployment compensation as income\u003c/a> when applying for health insurance plans. \u003ca href=\"https://www.healthcare.gov/income-and-household-information/income/\">Get advice on how to estimate your income on your application.\u003c/a>\u003c/p>\n\u003cp>\u003cb>First, check with your employer on when your health benefits will \u003ci>actually\u003c/i> end.\u003c/b>\u003c/p>\n\u003cp>Sometimes a severance package will offer a holdover of benefits, advises the San Francisco’s Human Services Agency’s Bart Ellison. Ask very specific questions of your human resources team, if you have one, about when the last day of your health care will be.\u003c/p>\n\u003cp>\u003cb>See if you can go on a family member’s health care.\u003c/b>\u003c/p>\n\u003cp>Losing your health care because of a job loss will likely qualify as a special enrollment period for joining a family member’s plan, if eligible.\u003c/p>\n\u003cp>If you have a domestic partner, you may be eligible to join their plan. If you’re under 26 years old, \u003ca href=\"https://www.healthcare.gov/young-adults/children-under-26/\">you may be able to join a parent’s plan\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_11945872\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11945872 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/04/pexels-cottonbro-studio-4778412.jpg\" alt=\"A person with medium-toned skin sits at a wooden table writing on a notepad, surrounded by books. They are wearing a gray t-shirt and have tattooed forearms. We can't see their face.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/pexels-cottonbro-studio-4778412.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/pexels-cottonbro-studio-4778412-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/pexels-cottonbro-studio-4778412-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/pexels-cottonbro-studio-4778412-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/pexels-cottonbro-studio-4778412-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Applying for benefits you’re entitled to can be a time-consuming process. \u003ccite>(cottonbro studio/Pexels)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>Medi-Cal\u003c/b>\u003c/p>\n\u003cp>Medi-Cal is California’s version of Medicaid, which offers health care to lower-income folks throughout the state. Eligibility is assessed by your household income, and for many people who qualify, there is no cost of getting health care through Medi-Cal.\u003c/p>\n\u003cp>Laws passed in the last few years in California mean that \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/youngadultexp.aspx\">undocumented people age 25 or under\u003c/a> and also \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/OlderAdultExpansion.aspx\">undocumented adults age 50 and over\u003c/a> are now eligible to receive Medi-Cal, too.\u003c/p>\n\u003cp>Unlike Covered California, \u003ca href=\"https://www.healthcare.gov/unemployed/\">Medi-Cal has no limited enrollment period\u003c/a> — you can sign up at any time of year if eligible, including if you’ve lost your job. If your children previously were getting health care through your employer’s plan, \u003ca href=\"https://www.insurekidsnow.gov/coverage/ca/index.html\">Medi-Cal — or the Children’s Health Insurance Program — may be able to cover them now\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014a.aspx#1\">See the state’s FAQ about Medi-Cal.\u003c/a> Medi-Cal and Covered California use the same application portal at \u003ca href=\"https://www.coveredca.com/apply/\">coveredca.com/apply\u003c/a>. Fill out your details, and the site will tell you whether your household income makes you eligible for Medi-Cal or whether you have to choose a private plan from Covered California.\u003c/p>\n\u003cp>\u003cb>Covered California\u003c/b>\u003c/p>\n\u003cp>Covered California is the state’s marketplace that offers private health insurance plans. Depending on your household income, you may qualify for a free or low-cost health plan through Covered California — or you may be eligible to receive financial help through Covered California that could help cover the costs of your premiums and co-pays. As with Medi-Cal, your household income is going to determine what you’re eligible for.\u003c/p>\n\u003cp>Leaving your job for any reason and subsequently \u003ca href=\"https://www.healthcare.gov/unemployed/\">losing your job-based health coverage qualifies for a special enrollment period\u003c/a> for signing up for a marketplace health plan. Usually, you’ll get 60 days from the day you lose your coverage to sign up for a health plan.\u003c/p>\n\u003cp>\u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014c.aspx#1\">See the state’s FAQ about Covered California.\u003c/a> Remember, Covered California uses the same application portal as Medi-Cal at \u003ca href=\"https://www.coveredca.com/apply/\">coveredca.com/apply\u003c/a>. Fill out your details, and the site will tell you whether your household income makes you eligible for Medi-Cal or whether you have to choose a private plan from Covered California.\u003c/p>\n\u003cp>\u003cb>COBRA\u003c/b>\u003c/p>\n\u003cp>COBRA stands for the federal Consolidated Omnibus Budget Reconciliation Act — and it’s a way of temporarily keeping health care after you leave a job. Instead of opting to sign up for Medi-Cal or a private health insurance plan through Covered California, you can choose so-called “continuation coverage” of your existing health care plan under COBRA, for a certain period of time.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/cobra_qna\">Health care through COBRA can be applied retroactively\u003c/a>, if you’re unsure about electing it straightaway. The catch: COBRA is expensive, because it’s the health plan your employer was previously paying part or all of — and now, you’re paying all the costs yourself.\u003c/p>\n\u003cp>\u003cb>Getting back onto health insurance taking a while? Know where your nearest community health center is.\u003c/b>\u003c/p>\n\u003cp>If you aren’t eligible for coverage through Medi-Cal, but signing up for another health plan is proving challenging right now, you can get low-cost health care at a nearby community health center. Make sure you know where your nearest one is, in case you need access to health care quickly. You can \u003ca href=\"https://findahealthcenter.hrsa.gov/\">use this map to find the closest community health center near you\u003c/a>.\u003c/p>\n\u003cp>\u003cb>More resources on finding health care after losing your job:\u003c/b>\u003c/p>\n\u003cul>\n\u003cli>“\u003ca href=\"https://www.coveredca.com/marketing-blog/health-insurance-for-the-unemployed-from-cobra-to-medi-cal/\">Health Insurance for the Unemployed, from COBRA to Medi-Cal\u003c/a>” (from coveredca.com)\u003c/li>\n\u003cli>“\u003ca href=\"https://www.healthcare.gov/unemployed/\">Health coverage options if you’re unemployed\u003c/a>” (from healthcare.gov)\u003c/li>\n\u003c/ul>\n\u003ch2>\u003ca id=\"otherbenefits\">\u003c/a>Step 3: Don’t forget about other benefits you could be entitled to\u003c/h2>\n\u003cp>The quickest way to see what benefits you might be eligible for now is to \u003ca href=\"https://benefitscal.com/ApplyForBenefits/ABOVR\">do one application through the state’s BenefitsCal portal\u003c/a>. This site will review your information and tell you what you may qualify for, including Medi-Cal.\u003c/p>\n\u003cp>The state says this application will take you between 30 minutes and an hour, and if you make an account you can save your progress and return to the application later, rather than having to start again. One catch: Not all counties in California are using this portal yet. \u003ca href=\"https://benefitscal.com/ApplyForBenefits/ABOVR\">Select your county from the drop-down menu\u003c/a> to see whether you have to use another site — \u003ca href=\"https://www.mybenefitscalwin.org/\">mybenefitscalwin.org\u003c/a> — instead.\u003c/p>\n\u003cp>The other benefits you could be entitled to may include:\u003c/p>\n\u003cp>\u003cb>CalFresh (SNAP)\u003c/b>\u003c/p>\n\u003cp>CalFresh is the state’s version of the federal Supplemental Nutrition Assistance Program (SNAP), the food benefits program also known as “food stamps.”\u003c/p>\n\u003cp>[aside postID=\"news_11943420\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2023/03/GettyImages-1144627849-1020x680.jpg\"]According to the state’s data from March 2023, over 3 million households use these funds to ensure they have access to food. You can \u003ca href=\"https://benefitscal.com/ApplyForBenefits/ABOVR\">apply through benefitscal.com\u003c/a>, which will also show you all other benefits you’re entitled to, or \u003ca href=\"https://www.getcalfresh.org/\">go direct through getcalfresh.org\u003c/a>.\u003c/p>\n\u003cp>\u003cb>CalWORKs (California Work Opportunity and Responsibility to Kids)\u003c/b>\u003c/p>\n\u003cp>If you have at least one child in your home, CalWORKs is a public assistance program that offers cash aid and services to eligible families. \u003ca href=\"https://benefitscal.com/\">See if your family is eligible to receive CalWORKs at benefitscal.com\u003c/a>.\u003c/p>\n\u003cp>\u003cb>WIC (Women, Infants and Children Supplemental Nutrition Program)\u003c/b>\u003c/p>\n\u003cp>WIC provides food assistance to lower-income families who have young children or are expecting a new child. Like CalFresh, it’s federally funded, and you can receive WIC benefits on top of your CalFresh benefits.\u003c/p>\n\u003cp>The program is income-based, and is available to pregnant people, plus new parents and grandparents of young children.\u003ca href=\"https://myfamily.wic.ca.gov/Home/HowCanIGetWIC#howToGetWIC\"> See whether you’re eligible for WIC and apply online.\u003c/a>\u003c/p>\n\u003cp>Make sure to read the rest of our KQED guides about other steps you can take after a layoff to better support yourself and those who depend on you:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"https://www.kqed.org/news/11949801/layoffs-how-to-find-a-new-job-jobhunting-tips\">The Best Ways to Find a New Job, According to an Expert\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"https://www.kqed.org/news/11949674/layoffs-mental-health-lost-job-self-care\">How to Prioritize Your Mental Health After Losing Your Job, From Telling Family to Self-Care\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"https://www.kqed.org/news/11948895/layoffs-how-to-save-more-money-after-losing-your-job\">How to Save More Money After Losing Your Job\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003ch2>\u003ca id=\"tellus\">\u003c/a>Tell us: What else do you need information about?\u003c/h2>\n\u003cp>At KQED News, we know that it can sometimes be hard to track down the answers to navigate life in the Bay Area. We’ve published \u003ca href=\"https://www.kqed.org/news/tag/coronavirus-resources-and-explainers\">clear, practical explainers and guides about COVID\u003c/a>, \u003ca href=\"https://www.kqed.org/news/11936674/how-to-prepare-for-this-weeks-atmospheric-river-storm-sandbags-emergency-kits-and-more\">how to cope with intense winter weather\u003c/a> and \u003ca href=\"https://www.kqed.org/news/11821950/how-to-safely-attend-a-protest-in-the-bay-area\">how to exercise your right to protest safely\u003c/a>.\u003c/p>\n\u003cp>So tell us: What do you need to know more about? Tell us, and you could see your question answered online or on social media. What you submit will make our reporting stronger, and help us decide what to cover here on our site, and on KQED Public Radio, too.\u003c/p>\n\u003cp>[hearken id=\"10483\" src=\"https://modules.wearehearken.com/kqed/embed/10483.js\"]\u003c/p>\n\u003cp>\u003cem>This story was originally published on May 19, 2023\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"Knowing what to do when you get laid off can feel daunting — especially if losing your job came as a shock. Check out our list of the initial steps to take after a layoff, to ensure you’re in as secure a place as possible.","status":"publish","parent":0,"modified":1705007979,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":true,"hasPolis":false,"paragraphCount":89,"wordCount":3722},"headData":{"title":"Layoffs: From Unemployment Benefits to Health Insurance, the Steps to Take ASAP | KQED","description":"Knowing what to do when you get laid off can feel daunting — especially if losing your job came as a shock. Check out our list of the initial steps to take after a layoff, to ensure you’re in as secure a place as possible.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"sticky":false,"excludeFromSiteSearch":"Include","articleAge":"0","path":"/news/11949192/layoffs-unemployment-benefits-health-insurance-calfresh","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This guide is part of the KQED News series \u003cstrong>\u003ca href=\"https://www.kqed.org/news/tag/what-to-do-after-a-layoff\">What to Do After a Layoff.\u003c/a>\u003c/strong>\u003c/em>\u003c/p>\n\u003cp>Knowing what to do when you get laid off can feel like a daunting prospect — especially if losing your job came as a total shock.\u003c/p>\n\u003cp>We’ve compiled a list of the initial steps to take after a layoff, to ensure you’re in as secure a place as possible. Jump straight to:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"#unemploymentbenefits\">Applying for unemployment benefits\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#healthinsurance\">Keeping your health insurance\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#otherbenefits\">Other benefits you might not know you’re eligible for\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003cp>… Or keep reading. As with the instructions for assembling furniture, you might find it helpful to read all this advice start to finish before you embark on these applications — to be prepared for any bumps you might encounter.\u003c/p>\n\u003ch2>Three tips to making applying for benefits after a layoff easier\u003c/h2>\n\u003cp>\u003cb>Your local government may have staff to help you do this\u003c/b>\u003c/p>\n\u003cp>Many cities and counties have their own offices, staff or programs specifically designed for people in your situation right now — which often have physical offices you can visit, or hotlines to call to ask a person your questions. These kinds of local resources can be particularly helpful in navigating the various benefits you could be entitled to, and aiding in the application processes.\u003c/p>\n\u003cp>Some offices, like the Department of Benefits and Family Support within \u003ca href=\"https://www.sfhsa.org/\">San Francisco’s Human Services Agency (SFHSA)\u003c/a>, can take your information in one central application and apply for those benefits on your behalf.\u003c/p>\n\u003cp>Having the help of a city staffer trained in these applications could save you a lot of time and stress, says Bart Ellison, program manager at SFHSA’s Workforce Development Division — not just because the process is streamlined, but because you’ll be able to ask these folks questions either in person or over the phone. It’s their job to help you — let them do it.\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"#tellus\">Tell us: What else do you need information about right now?\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003cp>Your city or county may also have a program to help you find new employment, like \u003ca href=\"https://www.sfhsa.org/services/jobs/jobsnow\">SFHSA’s free JobsNOW! program\u003c/a>, which is open to San Francisco job seekers based on their income level, and matches job hunters with roles.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdss.ca.gov/county-offices\">Find your local social services office in this statewide list.\u003c/a>\u003c/p>\n\u003cp>\u003cb>Don’t feel weird about claiming the benefits you’re owed\u003c/b>\u003c/p>\n\u003cp>When it comes to claiming benefits after a layoff, Ellison wants to remind you that “we all pay for this through our taxes.”\u003c/p>\n\u003cp>“It’s great that if you don’t need it, it’s there. If you do need it, it’s there, and it should be accessed,” Ellison said. “There’s no shame in any of that.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11957790,news_11970001,news_11967946,news_11968709","label":"COVID Resources and Explainers "},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>A lot of people also just don’t know about the benefits they could be eligible for, says Ellison, or assume they won’t qualify.\u003c/p>\n\u003cp>He also says that some of the eligible job seekers he and his team work with in San Francisco might fear coming forward to apply if a member of their family is undocumented, because they think it will cause them problems. “We don’t get involved in any of that,” said Ellison. “They should never fear that situation.”\u003c/p>\n\u003cp>\u003cb>Try to be patient with how long the application process could take\u003c/b>\u003c/p>\n\u003cp>Ellison says he and his team “try not to ask a client for documents that we know we already have in the system” — but concedes that sometimes, this process will feel like providing endless documentation. The benefits you’re applying for can be a mix of federal and state funds, so unfortunately “it’s not just as simple as coming in and saying, ‘Hi, I’m Bart, could you sign me up?,’” said Ellison.\u003c/p>\n\u003cp>The more you can follow through with any documentation requests, hopefully the faster and smoother your application process will go. “And if you need more time or need help gathering stuff, that is what the eligibility staff are there for,” said Ellison. “They are there to \u003ci>help \u003c/i>you find some of these things. So you just need to kind of be your own advocate, and speak up.”\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Read more layoff advice in our \u003ca href=\"https://www.kqed.org/news/tag/what-to-do-after-a-layoff\">What to Do After a Layoff \u003c/a>series\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003ch2>\u003ca id=\"unemploymentbenefits\">\u003c/a>Step 1: Apply for unemployment benefits\u003c/h2>\n\u003cp>If you’ve been laid off, \u003ca href=\"https://edd.ca.gov/en/unemployment/apply/\">apply for unemployment insurance\u003c/a> (UI, also known just as “unemployment”) from the California Employment Development Department (EDD) as soon as you can. Not only could it take at least three weeks to receive any benefits payments from a successful claim, but your claim begins when you first apply for it — not the day you lose your job. So time is of the essence.\u003c/p>\n\u003cp>\u003cb>Who can claim unemployment benefits?\u003c/b>\u003c/p>\n\u003cp>If you’re reading this and you \u003ci>chose\u003c/i> to leave your job, you usually aren’t eligible to claim unemployment. The exception to this is if you quit your job for what EDD calls “good cause,” which can include unsafe working conditions or a doctor’s advice. Whether or not you’re eligible to still claim UI in this situation will be determined by a phone interview with an EDD representative.\u003c/p>\n\u003cp>When applying for UI, you’ll have to show EDD that you have earned enough wages during the base period of 12 months, are totally or partially unemployed, are “unemployed through no fault of your own,” are physically able to work, are available for work and are ready and willing to accept work immediately.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>EDD will also ask you to show that you are “in satisfactory immigration status and authorized to work in the United States” not only now, but when you were earning the wages you’re using to establish your claim. EDD also warns that it will verify your immigration status and work authorization through the Department of Homeland Security.\u003c/p>\n\u003cp>You can \u003ca href=\"https://edd.ca.gov/en/unemployment/UI-Calculator/\">calculate the amount of unemployment benefits you can receive using this tool\u003c/a>. Remember that the amount of unemployment you’ll receive is based on your wages over the last 18 months, calculated by EDD from a base period of 12 months within that time — and if you didn’t earn any wages during that period, you won’t qualify for unemployment benefits.\u003c/p>\n\u003cp>\u003ca href=\"https://edd.ca.gov/en/unemployment/FAQ_-_Eligibility/\">See the EDD’s FAQ on who’s eligible to claim unemployment insurance.\u003c/a>\u003c/p>\n\u003cp>\u003cb>Gather your application information\u003c/b>\u003c/p>\n\u003cp>During your online application for UI, you’ll be asked to submit a lot of information — and it’s easiest to have all that gathered and ready, rather than trying to track it down in the middle of the process.\u003c/p>\n\u003cp>In addition to your basic identity information, you’ll need:\u003c/p>\n\u003cul>\n\u003cli>Your Social Security number\u003c/li>\n\u003cli>Your employment authorization information, if you’re not a U.S. citizen\u003c/li>\n\u003cli>A photo ID like a passport or driver’s license (for your ID.me account — more below)\u003c/li>\n\u003c/ul>\n\u003cp>You’ll also need to provide your employment history for the last 18 months, which will include:\u003c/p>\n\u003cul>\n\u003cli>The names of your previous employers\u003c/li>\n\u003cli>Their addresses\u003c/li>\n\u003cli>Their phone numbers\u003c/li>\n\u003cli>The reason each job ended\u003c/li>\n\u003cli>Your gross (total) wages earned\u003c/li>\n\u003cli>Hours worked per week\u003c/li>\n\u003cli>Hourly rate of pay\u003c/li>\n\u003c/ul>\n\u003cfigure id=\"attachment_11946480\" class=\"wp-caption alignnone\" style=\"max-width: 2560px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11946480 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/04/GettyImages-1400799758-scaled.jpg\" alt=\"A woman sits at her kitchen table and sifts through documents, looking concerned. Next to her is her opened laptop.\" width=\"2560\" height=\"1708\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/GettyImages-1400799758-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/GettyImages-1400799758-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/GettyImages-1400799758-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/GettyImages-1400799758-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/GettyImages-1400799758-1536x1025.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/GettyImages-1400799758-2048x1366.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/GettyImages-1400799758-1920x1281.jpg 1920w\" sizes=\"(max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">During your online application for UI, you’ll be asked to submit a lot of information — and it’s easiest to have all that gathered and ready, rather than trying to track it down in the middle of the process. \u003ccite>(MoMo Productions/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>Make the online accounts you’ll need to apply \u003c/b>\u003c/p>\n\u003cp>To apply for UI for the first time, you’ll need to \u003ca href=\"https://portal.edd.ca.gov/WebApp/Registration\">create a new Benefit Programs Online account\u003c/a>, to enable you to log in and manage your UI claim. (You may already have one of these accounts if you’ve previously applied for UI, disability insurance or paid family leave — in that case, use the same one.)\u003c/p>\n\u003cp>When you give an email address as part of your Benefit Programs Online application, make sure you check for any emails from EDD. When you get an email with a link to complete your registration, make sure you click that link within 48 hours of receiving it — otherwise, you’ll have to start the registration process all over again.\u003c/p>\n\u003cp>When you’ve created your Benefit Programs Online account, \u003ca href=\"https://edd.ca.gov/en/unemployment/ui_online/\">you’ll then register for UI Online\u003c/a>, which is the part of EDD’s online services that allows you to claim and manage your unemployment benefits. Keep reading for how to file your first UI claim.\u003c/p>\n\u003cp>You’ll \u003ci>also\u003c/i> need to \u003ca href=\"https://help.id.me/hc/en-us/articles/202673924-Creating-your-ID-me-account\">have an account with ID.me\u003c/a>, the identity verification EDD uses to make sure you’re really you when you’re claiming benefits. You can create your ID.me account before you create your Benefit Programs Online account, or when prompted during the process of creating it. If you’re creating your ID.me account beforehand, just make sure you keep the login details on hand so that you can sign into ID.me when prompted.\u003c/p>\n\u003cp>You might consider watching the \u003ca href=\"https://www.youtube.com/watch?v=moJ1mokMRgc\">EDD’s short instructional video on YouTube about creating these accounts and filing your first UI claim\u003c/a>, so you know what to expect during the process.\u003c/p>\n\u003cp>\u003cb>File your new UI claim\u003c/b>\u003c/p>\n\u003cp>One big thing: To start using UI Online, you’ll be asked for your “EDD Customer Account Number.” This is a number that’s unique to you, that you can also give instead of your Social Security number on the phone when speaking with an EDD representative. You should receive this number at the preferred email address you gave to EDD — in which case you can start using that EDD Customer Account Number immediately to register for UI Online. It’s also possible to \u003ca href=\"https://edd.ca.gov/en/unemployment/create-account/\">receive this number via mail “10 days after you file your claim,” says EDD\u003c/a>.\u003c/p>\n\u003cp>To file a new claim, \u003ca href=\"https://portal.edd.ca.gov/WebApp/Login?resource_url=https:%2F%2Fportal.edd.ca.gov%2FWebApp%2FHome\">log into your Benefit Programs Online account\u003c/a>, and under “UI Online” select “File New Claim.” Remember you’ll also be asked to briefly sign in to your ID.me account to verify your identity.\u003c/p>\n\u003cp>You can’t apply with UI Online 24/7, unfortunately — \u003ca href=\"https://edd.ca.gov/en/unemployment/ui_online/\">the site has hours of operation\u003c/a> (located on the File and Manage Account tab), which EDD says are currently (all times Pacific Standard Time):\u003c/p>\n\u003cul>\n\u003cli>Sunday: 5 a.m.–8:30 p.m.\u003c/li>\n\u003cli>Monday: 4 a.m.–10 p.m.\u003c/li>\n\u003cli>Tuesday–Friday: 2 a.m.–10 p.m.\u003c/li>\n\u003cli>Saturday: 2 a.m.–8 p.m.\u003c/li>\n\u003c/ul>\n\u003cp>If you need to pause during the UI Online application process, you can hit “Save as draft” to save your application to return to later — unless it’s \u003ci>after \u003c/i>8 p.m. on the Saturday of the week you’ve started the application. If it’s after 8 p.m. on Saturday, or you’re doing this on a Sunday, you won’t be able to save your application, and you will have to start it all over again if you exit.\u003c/p>\n\u003cp>If you’re having issues with UI Online, \u003ca href=\"https://edd.ca.gov/en/unemployment/ui_online/\">EDD recommends that you call their help line\u003c/a> at (833) 978-2511 and select option 1 after the introduction, available 8 a.m.–5 p.m., Monday through Friday. EDD says that Monday morning before 10 a.m. is their busiest call time.\u003c/p>\n\u003cp>\u003cb>Getting — and keeping — your unemployment benefits\u003c/b>\u003c/p>\n\u003cp>Once your application is complete, be aware of \u003ca href=\"https://edd.ca.gov/en/unemployment/After_You_Filed/\">the next steps and further information that EDD will ask of you\u003c/a>.\u003c/p>\n\u003cp>EDD says that \u003ca href=\"https://edd.ca.gov/en/unemployment/After_You_Filed/\">it “takes at least three weeks to process a claim\u003c/a> for unemployment benefits and issue payment to most eligible workers.” You’ll receive a debit card in the mail, which you can activate and then use to access your payments. If you have an old debit card from a previous UI claim, you can still use that one unless it’s expired (in which case you’ll be sent a new one).\u003c/p>\n\u003cp>To keep receiving UI after you first apply, you’ll have to certify for your unemployment benefits again every two weeks to continue receiving payments. You can do this online, by phone or through the mail, but EDD says you’ll get your payments faster if you certify online — and you’ll also get email reminders this way.\u003c/p>\n\u003cp>As part of this certification process every two weeks, you’ll have to \u003ca href=\"https://www.youtube.com/watch?v=3t_RgeoPH_g\">attest that you’re actively seeking employment\u003c/a>. This requirement was paused during the pandemic, but has since been reinstated. You’ll also need to \u003ca href=\"https://edd.ca.gov/en/jobs_and_training/Caljobs/\">register for CalJOBS and post your resume to the site\u003c/a> to keep receiving your UI benefits.\u003c/p>\n\u003cp>If you start doing any work again after losing your job, it’s very important that you report those earnings when you certify for your UI benefits — because those wages have to be deducted from your unemployment benefits. \u003ca href=\"https://edd.ca.gov/en/unemployment/FAQ-claims/#:~:text=Can%20I%20still%20collect%20benefits,deducted%20from%20your%20unemployment%20payments.\">Read more on how EDD will adjust your UI if you start earning money again while claiming unemployment benefits.\u003c/a>\u003c/p>\n\u003cp>And if you’re lucky enough to find a new full-time job, EDD is clear: “If you return to work full time, you will no longer be eligible for unemployment benefits.”\u003c/p>\n\u003cp>\u003ca href=\"https://edd.ca.gov/en/unemployment/certify/\">See EDD’s FAQ on certifying your UI claim every two weeks.\u003c/a>\u003c/p>\n\u003ch2>\u003ca id=\"healthinsurance\">\u003c/a>Step 2: Address your health insurance\u003c/h2>\n\u003cp>If your health insurance was tied to your employment, you need to act swiftly to ensure you’ll still have access to health care after your job ends. The option that’s best for you after your employment ends will depend primarily on how much income your household will now be receiving after you stop working.\u003c/p>\n\u003cp>Remember that if you’ve applied for unemployment benefits, \u003ca href=\"https://www.healthcare.gov/unemployed/\">you’ll need to declare that unemployment compensation as income\u003c/a> when applying for health insurance plans. \u003ca href=\"https://www.healthcare.gov/income-and-household-information/income/\">Get advice on how to estimate your income on your application.\u003c/a>\u003c/p>\n\u003cp>\u003cb>First, check with your employer on when your health benefits will \u003ci>actually\u003c/i> end.\u003c/b>\u003c/p>\n\u003cp>Sometimes a severance package will offer a holdover of benefits, advises the San Francisco’s Human Services Agency’s Bart Ellison. Ask very specific questions of your human resources team, if you have one, about when the last day of your health care will be.\u003c/p>\n\u003cp>\u003cb>See if you can go on a family member’s health care.\u003c/b>\u003c/p>\n\u003cp>Losing your health care because of a job loss will likely qualify as a special enrollment period for joining a family member’s plan, if eligible.\u003c/p>\n\u003cp>If you have a domestic partner, you may be eligible to join their plan. If you’re under 26 years old, \u003ca href=\"https://www.healthcare.gov/young-adults/children-under-26/\">you may be able to join a parent’s plan\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_11945872\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11945872 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/04/pexels-cottonbro-studio-4778412.jpg\" alt=\"A person with medium-toned skin sits at a wooden table writing on a notepad, surrounded by books. They are wearing a gray t-shirt and have tattooed forearms. We can't see their face.\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/pexels-cottonbro-studio-4778412.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/pexels-cottonbro-studio-4778412-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/pexels-cottonbro-studio-4778412-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/pexels-cottonbro-studio-4778412-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/04/pexels-cottonbro-studio-4778412-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Applying for benefits you’re entitled to can be a time-consuming process. \u003ccite>(cottonbro studio/Pexels)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cb>Medi-Cal\u003c/b>\u003c/p>\n\u003cp>Medi-Cal is California’s version of Medicaid, which offers health care to lower-income folks throughout the state. Eligibility is assessed by your household income, and for many people who qualify, there is no cost of getting health care through Medi-Cal.\u003c/p>\n\u003cp>Laws passed in the last few years in California mean that \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/youngadultexp.aspx\">undocumented people age 25 or under\u003c/a> and also \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/OlderAdultExpansion.aspx\">undocumented adults age 50 and over\u003c/a> are now eligible to receive Medi-Cal, too.\u003c/p>\n\u003cp>Unlike Covered California, \u003ca href=\"https://www.healthcare.gov/unemployed/\">Medi-Cal has no limited enrollment period\u003c/a> — you can sign up at any time of year if eligible, including if you’ve lost your job. If your children previously were getting health care through your employer’s plan, \u003ca href=\"https://www.insurekidsnow.gov/coverage/ca/index.html\">Medi-Cal — or the Children’s Health Insurance Program — may be able to cover them now\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014a.aspx#1\">See the state’s FAQ about Medi-Cal.\u003c/a> Medi-Cal and Covered California use the same application portal at \u003ca href=\"https://www.coveredca.com/apply/\">coveredca.com/apply\u003c/a>. Fill out your details, and the site will tell you whether your household income makes you eligible for Medi-Cal or whether you have to choose a private plan from Covered California.\u003c/p>\n\u003cp>\u003cb>Covered California\u003c/b>\u003c/p>\n\u003cp>Covered California is the state’s marketplace that offers private health insurance plans. Depending on your household income, you may qualify for a free or low-cost health plan through Covered California — or you may be eligible to receive financial help through Covered California that could help cover the costs of your premiums and co-pays. As with Medi-Cal, your household income is going to determine what you’re eligible for.\u003c/p>\n\u003cp>Leaving your job for any reason and subsequently \u003ca href=\"https://www.healthcare.gov/unemployed/\">losing your job-based health coverage qualifies for a special enrollment period\u003c/a> for signing up for a marketplace health plan. Usually, you’ll get 60 days from the day you lose your coverage to sign up for a health plan.\u003c/p>\n\u003cp>\u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014c.aspx#1\">See the state’s FAQ about Covered California.\u003c/a> Remember, Covered California uses the same application portal as Medi-Cal at \u003ca href=\"https://www.coveredca.com/apply/\">coveredca.com/apply\u003c/a>. Fill out your details, and the site will tell you whether your household income makes you eligible for Medi-Cal or whether you have to choose a private plan from Covered California.\u003c/p>\n\u003cp>\u003cb>COBRA\u003c/b>\u003c/p>\n\u003cp>COBRA stands for the federal Consolidated Omnibus Budget Reconciliation Act — and it’s a way of temporarily keeping health care after you leave a job. Instead of opting to sign up for Medi-Cal or a private health insurance plan through Covered California, you can choose so-called “continuation coverage” of your existing health care plan under COBRA, for a certain period of time.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/cobra_qna\">Health care through COBRA can be applied retroactively\u003c/a>, if you’re unsure about electing it straightaway. The catch: COBRA is expensive, because it’s the health plan your employer was previously paying part or all of — and now, you’re paying all the costs yourself.\u003c/p>\n\u003cp>\u003cb>Getting back onto health insurance taking a while? Know where your nearest community health center is.\u003c/b>\u003c/p>\n\u003cp>If you aren’t eligible for coverage through Medi-Cal, but signing up for another health plan is proving challenging right now, you can get low-cost health care at a nearby community health center. Make sure you know where your nearest one is, in case you need access to health care quickly. You can \u003ca href=\"https://findahealthcenter.hrsa.gov/\">use this map to find the closest community health center near you\u003c/a>.\u003c/p>\n\u003cp>\u003cb>More resources on finding health care after losing your job:\u003c/b>\u003c/p>\n\u003cul>\n\u003cli>“\u003ca href=\"https://www.coveredca.com/marketing-blog/health-insurance-for-the-unemployed-from-cobra-to-medi-cal/\">Health Insurance for the Unemployed, from COBRA to Medi-Cal\u003c/a>” (from coveredca.com)\u003c/li>\n\u003cli>“\u003ca href=\"https://www.healthcare.gov/unemployed/\">Health coverage options if you’re unemployed\u003c/a>” (from healthcare.gov)\u003c/li>\n\u003c/ul>\n\u003ch2>\u003ca id=\"otherbenefits\">\u003c/a>Step 3: Don’t forget about other benefits you could be entitled to\u003c/h2>\n\u003cp>The quickest way to see what benefits you might be eligible for now is to \u003ca href=\"https://benefitscal.com/ApplyForBenefits/ABOVR\">do one application through the state’s BenefitsCal portal\u003c/a>. This site will review your information and tell you what you may qualify for, including Medi-Cal.\u003c/p>\n\u003cp>The state says this application will take you between 30 minutes and an hour, and if you make an account you can save your progress and return to the application later, rather than having to start again. One catch: Not all counties in California are using this portal yet. \u003ca href=\"https://benefitscal.com/ApplyForBenefits/ABOVR\">Select your county from the drop-down menu\u003c/a> to see whether you have to use another site — \u003ca href=\"https://www.mybenefitscalwin.org/\">mybenefitscalwin.org\u003c/a> — instead.\u003c/p>\n\u003cp>The other benefits you could be entitled to may include:\u003c/p>\n\u003cp>\u003cb>CalFresh (SNAP)\u003c/b>\u003c/p>\n\u003cp>CalFresh is the state’s version of the federal Supplemental Nutrition Assistance Program (SNAP), the food benefits program also known as “food stamps.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11943420","hero":"https://ww2.kqed.org/app/uploads/sites/10/2023/03/GettyImages-1144627849-1020x680.jpg","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>According to the state’s data from March 2023, over 3 million households use these funds to ensure they have access to food. You can \u003ca href=\"https://benefitscal.com/ApplyForBenefits/ABOVR\">apply through benefitscal.com\u003c/a>, which will also show you all other benefits you’re entitled to, or \u003ca href=\"https://www.getcalfresh.org/\">go direct through getcalfresh.org\u003c/a>.\u003c/p>\n\u003cp>\u003cb>CalWORKs (California Work Opportunity and Responsibility to Kids)\u003c/b>\u003c/p>\n\u003cp>If you have at least one child in your home, CalWORKs is a public assistance program that offers cash aid and services to eligible families. \u003ca href=\"https://benefitscal.com/\">See if your family is eligible to receive CalWORKs at benefitscal.com\u003c/a>.\u003c/p>\n\u003cp>\u003cb>WIC (Women, Infants and Children Supplemental Nutrition Program)\u003c/b>\u003c/p>\n\u003cp>WIC provides food assistance to lower-income families who have young children or are expecting a new child. Like CalFresh, it’s federally funded, and you can receive WIC benefits on top of your CalFresh benefits.\u003c/p>\n\u003cp>The program is income-based, and is available to pregnant people, plus new parents and grandparents of young children.\u003ca href=\"https://myfamily.wic.ca.gov/Home/HowCanIGetWIC#howToGetWIC\"> See whether you’re eligible for WIC and apply online.\u003c/a>\u003c/p>\n\u003cp>Make sure to read the rest of our KQED guides about other steps you can take after a layoff to better support yourself and those who depend on you:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"https://www.kqed.org/news/11949801/layoffs-how-to-find-a-new-job-jobhunting-tips\">The Best Ways to Find a New Job, According to an Expert\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"https://www.kqed.org/news/11949674/layoffs-mental-health-lost-job-self-care\">How to Prioritize Your Mental Health After Losing Your Job, From Telling Family to Self-Care\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"https://www.kqed.org/news/11948895/layoffs-how-to-save-more-money-after-losing-your-job\">How to Save More Money After Losing Your Job\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003ch2>\u003ca id=\"tellus\">\u003c/a>Tell us: What else do you need information about?\u003c/h2>\n\u003cp>At KQED News, we know that it can sometimes be hard to track down the answers to navigate life in the Bay Area. We’ve published \u003ca href=\"https://www.kqed.org/news/tag/coronavirus-resources-and-explainers\">clear, practical explainers and guides about COVID\u003c/a>, \u003ca href=\"https://www.kqed.org/news/11936674/how-to-prepare-for-this-weeks-atmospheric-river-storm-sandbags-emergency-kits-and-more\">how to cope with intense winter weather\u003c/a> and \u003ca href=\"https://www.kqed.org/news/11821950/how-to-safely-attend-a-protest-in-the-bay-area\">how to exercise your right to protest safely\u003c/a>.\u003c/p>\n\u003cp>So tell us: What do you need to know more about? Tell us, and you could see your question answered online or on social media. What you submit will make our reporting stronger, and help us decide what to cover here on our site, and on KQED Public Radio, too.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"hearken","attributes":{"named":{"id":"10483","src":"https://modules.wearehearken.com/kqed/embed/10483.js","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was originally published on May 19, 2023\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11949192/layoffs-unemployment-benefits-health-insurance-calfresh","authors":["3243"],"categories":["news_8"],"tags":["news_32707","news_5164","news_28339","news_31848","news_27626","news_1054","news_352","news_32053","news_2605","news_28004","news_631","news_30130","news_32735"],"featImg":"news_11949742","label":"news"},"news_11971055":{"type":"posts","id":"news_11971055","meta":{"index":"posts_1591205157","site":"news","id":"11971055","score":null,"sort":[1703851255000]},"guestAuthors":[],"slug":"new-california-law-bans-surprise-ambulance-bills-that-can-put-families-in-debt","title":"New California Law Bans Surprise Ambulance Bills That Can Put Families in Debt","publishDate":1703851255,"format":"standard","headTitle":"New California Law Bans Surprise Ambulance Bills That Can Put Families in Debt | KQED","labelTerm":{"term":18481,"site":"news"},"content":"\u003cp>\u003cem>Lea este artículo en \u003ca href=\"https://calmatters.org/calmatters-en-espanol/2023/12/las-carisimas-facturas-por-uso-de-ambulancias-endeudaron-a-estas-familias-pero-una-nueva-ley-de-california-prohibe-la-practica/\">español\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>The COVID-19 pandemic took a brutal toll on Danielle Miele’s family. But after two exorbitant ambulance bills, she’s now scared to call 911.\u003c/p>\n\u003cp>Her teenage son attempted suicide in 2022, Miele said. His mental health deteriorated during the pandemic, and he needed an ambulance transfer from the Roseville emergency room, where Miele took him to a treatment center in San Mateo. The ambulance company hit Miele with a $9,000 out-of-network charge, which was sent to collections “almost immediately,” she said.[pullquote align=\"right\" size=\"medium\" citation=\"Katie Van Deynze, Health Access California\"]‘It’s the last remaining gap, but it’s a really big one. You could be insured, but it doesn’t matter.’[/pullquote]The virus also left Miele with seizures that mimic the symptoms of a heart attack, she said. Miele called 911 the first time a seizure happened. The 15-minute ride to the hospital cost $4,000 without help from insurance, she said.\u003c/p>\n\u003cp>“The last time I had one of my seizures, I basically said, ‘I’m going to die here at home. … I’m not getting another ambulance,’” Miele said. “I’d maybe rather die at home than have more medical debt.”\u003c/p>\n\u003cp>A \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB716\" target=\"_blank\" rel=\"noreferrer noopener\">new California law\u003c/a> that takes effect Jan. 1 targets the kind of “surprise” ambulance bills that put Miele’s family in debt, even though they had medical insurance. These bills take the form of out-of-network charges for privately insured patients without control over which ambulance company responds to a call for help.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Under the new law, patients will only have to pay the equivalent of what they would have paid for an in-network service. Health insurance and ambulance companies will have to settle the bill directly even if they don’t have an existing contract.\u003c/p>\n\u003cp>Supporters of the new law argue it will make a big difference for thousands of families like Miele’s. The second time that Miele’s son needed an emergency psychiatric hold, the ambulance company that arrived was part of the family’s insurance network. Their co-pay: $83.\u003c/p>\n\u003cp>Ambulance companies did not oppose the legislation, which includes guarantees that health insurance plans reimburse them for services.\u003c/p>\n\u003ch2>Millions in surprise bills\u003c/h2>\n\u003cp>The California Association of Health Plans, which represents insurers, opposed the bill before it became law because of its potential to increase premiums by $67.3 million statewide. In contrast, people with private health insurance stand to save approximately $44.5 million in \u003ca href=\"https://www.chbrp.org/sites/default/files/bill-documents/AB716/AB%20716%20Final.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">direct\u003c/a>\u003ca href=\"https://www.chbrp.org/sites/default/files/bill-documents/AB716/AB%20716%20Final.pdf\"> charges for ambulance rides\u003c/a>, according to a legislative analysis.\u003c/p>\n\u003cp>Katie Van Deynze, a legislative advocate for Health Access California, a consumer advocacy group that sponsored the legislation, said the law closes a longstanding gap in California’s \u003ca href=\"https://www.insurance.ca.gov/01-consumers/110-health/60-resources/NoSupriseBills.cfm\" target=\"_blank\" rel=\"noreferrer noopener\">consumer\u003c/a>\u003ca href=\"https://www.insurance.ca.gov/01-consumers/110-health/60-resources/NoSupriseBills.cfm\"> protections against surprise medical billing\u003c/a> for patients with private insurance.\u003c/p>\n\u003cp>“It’s the last remaining gap, but it’s a really big one,” she said. “You could be insured, but it doesn’t matter.”\u003c/p>\n\u003cfigure id=\"attachment_11971057\" class=\"wp-caption alignnone\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/121923-Surprise-Ambulance-LV_01-CM.jpeg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11971057\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/121923-Surprise-Ambulance-LV_01-CM.jpeg\" alt=\"A woman with glasses, sitting on an easy chair, holds a little boy on her lap.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/121923-Surprise-Ambulance-LV_01-CM.jpeg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/121923-Surprise-Ambulance-LV_01-CM-800x533.jpeg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/121923-Surprise-Ambulance-LV_01-CM-1020x680.jpeg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/121923-Surprise-Ambulance-LV_01-CM-160x107.jpeg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/121923-Surprise-Ambulance-LV_01-CM-1536x1024.jpeg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/121923-Surprise-Ambulance-LV_01-CM-1920x1280.jpeg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lainey Arebalo and her son Brady sitting in the living room of her parents’ home in Templeton, California, on Dec. 19, 2023. Minutes after Arebalo gave birth to Brady, doctors had him transported by ambulance to a neonatal intensive care unit, leaving the family with a hefty ambulance bill. \u003ccite>(Larry Valenzuela/CalMatters, CatchLight Local)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Approximately 14 million Californians with state-regulated private health plans will benefit from the law’s protections. According to an analysis by the Kaiser Family Foundation, \u003ca href=\"https://www.healthsystemtracker.org/brief/ground-ambulance-rides-and-potential-for-surprise-billing/#Among%20privately%20insured%20non-elderly%20people%20with%20an%20emergency%20room%20(ER)%20visit,%20the%20share%20who%20arrived%20to%20the%20ER%20by%20ambulance,%202018\">73% of all ground ambulance \u003c/a>\u003ca href=\"https://www.healthsystemtracker.org/brief/ground-ambulance-rides-and-potential-for-surprise-billing/#Among%20privately%20insured%20non-elderly%20people%20with%20an%20emergency%20room%20(ER)%20visit,%20the%20share%20who%20arrived%20to%20the%20ER%20by%20ambulance,%202018\" target=\"_blank\" rel=\"noreferrer noopener\">transports\u003c/a> in California resulted in an out-of-network charge in 2018 among people with large employer insurance. California also has the nation’s \u003ca href=\"https://publicinterestnetwork.org/wp-content/uploads/2022/12/EMERGENCY-The-high-cost-of-ambulance-surprise-bills-USPIRG-Education-Fund-December-2022-Final.pdf#=page9\" target=\"_blank\" rel=\"noreferrer noopener\">highest median surprise ambulance bill\u003c/a>, at $1,209, according to a study published last year by the U.S. Public Interest Research Group.\u003c/p>\n\u003cp>In a statement at the time of the law’s passage, Assemblymember \u003ca href=\"https://calmatters.org/legislator-tracker/tasha-boerner-horvath-1973/\">Tasha Boerner\u003c/a>, the Democrat from Carlsbad who authored the measure, said people have no control over which ambulance company picks them up in a time of crisis.\u003c/p>\n\u003cp>“The last thing anyone should be thinking about when they call 911 is whether they can afford the ambulance ride,” Boerner said in her statement.\u003c/p>\n\u003cp>[aside label=\"more health coverage\" tag=\"health-care\"]The law also protects uninsured people from receiving an expensive ambulance bill by limiting their out-of-pocket cost to the Medi-Cal or Medicare rate, whichever is greater. Medi-Cal is the state’s health insurance program for very low-income residents and already protects its enrollees from these types of bills.\u003c/p>\n\u003cp>About 6 million Californians enrolled in federally regulated health plans, many of whom work for multi-state or multinational companies, won’t be shielded by the law. Californians can ask their employer what kind of health plan they offer.\u003c/p>\n\u003ch2>$4,400 bill for newborn’s ambulance trip\u003c/h2>\n\u003cp>Lainey Arebalo is thankful that future emergencies will be covered in California. Her health insurance company doesn’t contract with any ambulance companies in San Luis Obispo County, where she and her family live, leaving them with no choice but to pay out of pocket.\u003c/p>\n\u003cp>In September, minutes after Arebalo gave birth to her son Brady, doctors decided to transfer him to a larger hospital about 20 miles away. Brady wasn’t breathing properly and needed to be admitted to a neonatal intensive care unit. The ambulance came and whisked him away.\u003c/p>\n\u003cp>Over the next month, letters started arriving from the ambulance company: Arebalo owed $4,400 for the transfer, she said.\u003c/p>\n\u003cp>“Here I am, you know, less than two months after giving birth, being told I would be sent to collections,” she said.\u003c/p>\n\u003cp>Insurance covered nearly all of Brady’s five-day hospital stay, which totaled $109,000, Arebalo said, but wouldn’t pay for the out-of-network ambulance ride. Eventually, insurance paid about a third of the bill after Arebalo filed a grievance, but the remaining unexpected expense still cut into the family’s finances.\u003c/p>\n\u003cp>She ended her maternity leave early to return to work as a special education teacher to help pay the bills and is now on a payment plan of $200 per month.\u003c/p>\n\u003cp>“It was definitely a surprise bill and one that I’m still paying,” Arebalo said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Supported by the California Health Care Foundation (CHCF), which works to ensure that\u003c/em> \u003cem>people have access to the care they need, when they need it, at a price they can afford. Visit \u003c/em>\u003ca href=\"http://www.chcf.org/\">\u003cem>www.chcf.org\u003c/em>\u003c/a>\u003cem> to learn more.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Surprise ambulance bills can leave families deeply in debt after a medical emergency. A new state law forcing insurance companies to negotiate payments is expected to save Californians tens of millions of dollars a year.","status":"publish","parent":0,"modified":1703869238,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":26,"wordCount":1140},"headData":{"title":"New California Law Bans Surprise Ambulance Bills That Can Put Families in Debt | KQED","description":"Surprise ambulance bills can leave families deeply in debt after a medical emergency. A new state law forcing insurance companies to negotiate payments is expected to save Californians tens of millions of dollars a year.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"sticky":false,"nprByline":"\u003ca href=\"https://calmatters.org/author/kristen-hwang/\">Kristen Hwang\u003c/a>","excludeFromSiteSearch":"Include","showOnAuthorArchivePages":"No","articleAge":"0","path":"/news/11971055/new-california-law-bans-surprise-ambulance-bills-that-can-put-families-in-debt","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Lea este artículo en \u003ca href=\"https://calmatters.org/calmatters-en-espanol/2023/12/las-carisimas-facturas-por-uso-de-ambulancias-endeudaron-a-estas-familias-pero-una-nueva-ley-de-california-prohibe-la-practica/\">español\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>The COVID-19 pandemic took a brutal toll on Danielle Miele’s family. But after two exorbitant ambulance bills, she’s now scared to call 911.\u003c/p>\n\u003cp>Her teenage son attempted suicide in 2022, Miele said. His mental health deteriorated during the pandemic, and he needed an ambulance transfer from the Roseville emergency room, where Miele took him to a treatment center in San Mateo. The ambulance company hit Miele with a $9,000 out-of-network charge, which was sent to collections “almost immediately,” she said.\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘It’s the last remaining gap, but it’s a really big one. You could be insured, but it doesn’t matter.’","name":"pullquote","attributes":{"named":{"align":"right","size":"medium","citation":"Katie Van Deynze, Health Access California","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>The virus also left Miele with seizures that mimic the symptoms of a heart attack, she said. Miele called 911 the first time a seizure happened. The 15-minute ride to the hospital cost $4,000 without help from insurance, she said.\u003c/p>\n\u003cp>“The last time I had one of my seizures, I basically said, ‘I’m going to die here at home. … I’m not getting another ambulance,’” Miele said. “I’d maybe rather die at home than have more medical debt.”\u003c/p>\n\u003cp>A \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB716\" target=\"_blank\" rel=\"noreferrer noopener\">new California law\u003c/a> that takes effect Jan. 1 targets the kind of “surprise” ambulance bills that put Miele’s family in debt, even though they had medical insurance. These bills take the form of out-of-network charges for privately insured patients without control over which ambulance company responds to a call for help.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Under the new law, patients will only have to pay the equivalent of what they would have paid for an in-network service. Health insurance and ambulance companies will have to settle the bill directly even if they don’t have an existing contract.\u003c/p>\n\u003cp>Supporters of the new law argue it will make a big difference for thousands of families like Miele’s. The second time that Miele’s son needed an emergency psychiatric hold, the ambulance company that arrived was part of the family’s insurance network. Their co-pay: $83.\u003c/p>\n\u003cp>Ambulance companies did not oppose the legislation, which includes guarantees that health insurance plans reimburse them for services.\u003c/p>\n\u003ch2>Millions in surprise bills\u003c/h2>\n\u003cp>The California Association of Health Plans, which represents insurers, opposed the bill before it became law because of its potential to increase premiums by $67.3 million statewide. In contrast, people with private health insurance stand to save approximately $44.5 million in \u003ca href=\"https://www.chbrp.org/sites/default/files/bill-documents/AB716/AB%20716%20Final.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">direct\u003c/a>\u003ca href=\"https://www.chbrp.org/sites/default/files/bill-documents/AB716/AB%20716%20Final.pdf\"> charges for ambulance rides\u003c/a>, according to a legislative analysis.\u003c/p>\n\u003cp>Katie Van Deynze, a legislative advocate for Health Access California, a consumer advocacy group that sponsored the legislation, said the law closes a longstanding gap in California’s \u003ca href=\"https://www.insurance.ca.gov/01-consumers/110-health/60-resources/NoSupriseBills.cfm\" target=\"_blank\" rel=\"noreferrer noopener\">consumer\u003c/a>\u003ca href=\"https://www.insurance.ca.gov/01-consumers/110-health/60-resources/NoSupriseBills.cfm\"> protections against surprise medical billing\u003c/a> for patients with private insurance.\u003c/p>\n\u003cp>“It’s the last remaining gap, but it’s a really big one,” she said. “You could be insured, but it doesn’t matter.”\u003c/p>\n\u003cfigure id=\"attachment_11971057\" class=\"wp-caption alignnone\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/121923-Surprise-Ambulance-LV_01-CM.jpeg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11971057\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/121923-Surprise-Ambulance-LV_01-CM.jpeg\" alt=\"A woman with glasses, sitting on an easy chair, holds a little boy on her lap.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/121923-Surprise-Ambulance-LV_01-CM.jpeg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/121923-Surprise-Ambulance-LV_01-CM-800x533.jpeg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/121923-Surprise-Ambulance-LV_01-CM-1020x680.jpeg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/121923-Surprise-Ambulance-LV_01-CM-160x107.jpeg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/121923-Surprise-Ambulance-LV_01-CM-1536x1024.jpeg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2023/12/121923-Surprise-Ambulance-LV_01-CM-1920x1280.jpeg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lainey Arebalo and her son Brady sitting in the living room of her parents’ home in Templeton, California, on Dec. 19, 2023. Minutes after Arebalo gave birth to Brady, doctors had him transported by ambulance to a neonatal intensive care unit, leaving the family with a hefty ambulance bill. \u003ccite>(Larry Valenzuela/CalMatters, CatchLight Local)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Approximately 14 million Californians with state-regulated private health plans will benefit from the law’s protections. According to an analysis by the Kaiser Family Foundation, \u003ca href=\"https://www.healthsystemtracker.org/brief/ground-ambulance-rides-and-potential-for-surprise-billing/#Among%20privately%20insured%20non-elderly%20people%20with%20an%20emergency%20room%20(ER)%20visit,%20the%20share%20who%20arrived%20to%20the%20ER%20by%20ambulance,%202018\">73% of all ground ambulance \u003c/a>\u003ca href=\"https://www.healthsystemtracker.org/brief/ground-ambulance-rides-and-potential-for-surprise-billing/#Among%20privately%20insured%20non-elderly%20people%20with%20an%20emergency%20room%20(ER)%20visit,%20the%20share%20who%20arrived%20to%20the%20ER%20by%20ambulance,%202018\" target=\"_blank\" rel=\"noreferrer noopener\">transports\u003c/a> in California resulted in an out-of-network charge in 2018 among people with large employer insurance. California also has the nation’s \u003ca href=\"https://publicinterestnetwork.org/wp-content/uploads/2022/12/EMERGENCY-The-high-cost-of-ambulance-surprise-bills-USPIRG-Education-Fund-December-2022-Final.pdf#=page9\" target=\"_blank\" rel=\"noreferrer noopener\">highest median surprise ambulance bill\u003c/a>, at $1,209, according to a study published last year by the U.S. Public Interest Research Group.\u003c/p>\n\u003cp>In a statement at the time of the law’s passage, Assemblymember \u003ca href=\"https://calmatters.org/legislator-tracker/tasha-boerner-horvath-1973/\">Tasha Boerner\u003c/a>, the Democrat from Carlsbad who authored the measure, said people have no control over which ambulance company picks them up in a time of crisis.\u003c/p>\n\u003cp>“The last thing anyone should be thinking about when they call 911 is whether they can afford the ambulance ride,” Boerner said in her statement.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"label":"more health coverage ","tag":"health-care"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>The law also protects uninsured people from receiving an expensive ambulance bill by limiting their out-of-pocket cost to the Medi-Cal or Medicare rate, whichever is greater. Medi-Cal is the state’s health insurance program for very low-income residents and already protects its enrollees from these types of bills.\u003c/p>\n\u003cp>About 6 million Californians enrolled in federally regulated health plans, many of whom work for multi-state or multinational companies, won’t be shielded by the law. Californians can ask their employer what kind of health plan they offer.\u003c/p>\n\u003ch2>$4,400 bill for newborn’s ambulance trip\u003c/h2>\n\u003cp>Lainey Arebalo is thankful that future emergencies will be covered in California. Her health insurance company doesn’t contract with any ambulance companies in San Luis Obispo County, where she and her family live, leaving them with no choice but to pay out of pocket.\u003c/p>\n\u003cp>In September, minutes after Arebalo gave birth to her son Brady, doctors decided to transfer him to a larger hospital about 20 miles away. Brady wasn’t breathing properly and needed to be admitted to a neonatal intensive care unit. The ambulance came and whisked him away.\u003c/p>\n\u003cp>Over the next month, letters started arriving from the ambulance company: Arebalo owed $4,400 for the transfer, she said.\u003c/p>\n\u003cp>“Here I am, you know, less than two months after giving birth, being told I would be sent to collections,” she said.\u003c/p>\n\u003cp>Insurance covered nearly all of Brady’s five-day hospital stay, which totaled $109,000, Arebalo said, but wouldn’t pay for the out-of-network ambulance ride. Eventually, insurance paid about a third of the bill after Arebalo filed a grievance, but the remaining unexpected expense still cut into the family’s finances.\u003c/p>\n\u003cp>She ended her maternity leave early to return to work as a special education teacher to help pay the bills and is now on a payment plan of $200 per month.\u003c/p>\n\u003cp>“It was definitely a surprise bill and one that I’m still paying,” Arebalo said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Supported by the California Health Care Foundation (CHCF), which works to ensure that\u003c/em> \u003cem>people have access to the care they need, when they need it, at a price they can afford. Visit \u003c/em>\u003ca href=\"http://www.chcf.org/\">\u003cem>www.chcf.org\u003c/em>\u003c/a>\u003cem> to learn more.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11971055/new-california-law-bans-surprise-ambulance-bills-that-can-put-families-in-debt","authors":["byline_news_11971055"],"categories":["news_8"],"tags":["news_18543","news_683","news_1054"],"affiliates":["news_18481"],"featImg":"news_11935568","label":"news_18481"},"news_11969300":{"type":"posts","id":"news_11969300","meta":{"index":"posts_1591205157","site":"news","id":"11969300","score":null,"sort":[1701991816000]},"guestAuthors":[],"slug":"how-to-get-reimbursed-for-at-home-covid-tests-in-2023","title":"How to Get Reimbursed for At-Home COVID Tests This Winter","publishDate":1701991816,"format":"standard","headTitle":"How to Get Reimbursed for At-Home COVID Tests This Winter | KQED","labelTerm":{"site":"news"},"content":"\u003cp>\u003cem>Updated 1:30 p.m. Wednesday\u003c/em>\u003c/p>\n\u003cp>Winter in California has begun with foggy mornings, rainy nights and planning holiday dinners with family and friends. And like the past few winters, we’re also seeing COVID-19 infections creep back up across the state despite less free and easily accessible testing sites.\u003c/p>\n\u003cp>In early November, 6.2% of the PCR tests for COVID-19 administered in California came back positive, \u003ca href=\"https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Respiratory-Viruses/RespiratoryDashboard.aspx\">according to the state’s most recent data showing the seven-day average of those positivity rates.\u003c/a> One month later, the state’s most recent data from Dec. 4 shows that this rate has climbed to 8.8%.\u003c/p>\n\u003cp>The rate of positive COVID-19 tests has increased every winter since the start of the pandemic. In January 2022, the infection rate surpassed 20%, partly due to the spread of the powerful omicron variant. During that time, one out of every five tests administered in the state came back positive.\u003c/p>\n\u003cp>Even if you’re up to date with your vaccines and have \u003ca href=\"https://www.kqed.org/news/11960630/free-new-covid-vaccine-near-me-2023\">received the new updated COVID-19 vaccine\u003c/a>, it’s perfectly normal to feel still anxious about the coronavirus, especially if you plan to spend time with family and friends during the holiday season. On Nov. 30, public health officials from all nine Bay Area counties \u003ca href=\"https://sf.gov/news/respiratory-viruses-circulating-all-bay-area-health-officers-recommend-actions-stay-healthy\">published a list of recommendations to prevent respiratory infections\u003c/a> (COVID-19, RSV and the flu) during the holidays. Among these recommendations is stocking up on at-home COVID-19 tests.[aside postID=\"news_11940562\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2023/02/RS62644_GettyImages-1237599780-qut-1020x680.jpg\"]The federal government is still \u003ca href=\"https://www.kqed.org/news/11940562/how-to-find-a-free-covid-test-near-you-in-2023-because-its-getting-harder\">giving out four free COVID-19 tests to every household\u003c/a>. And yes, for many families four tests may just not be enough, especially considering that the high season for COVID-19 infections lasts several months. However, many insurance companies in California will still reimburse you for at-home tests you buy at the store or pharmacy.\u003c/p>\n\u003cp>The process of reimbursing for at-home COVID-19 tests \u003ca href=\"https://www.latimes.com/california/story/2023-02-07/with-covid-emergency-ending-will-i-have-to-pay-for-tests\">has changed in the last month\u003c/a>, and each insurer is reimbursing members differently. KQED reached out to every major health insurance company in California to learn what they’re doing and what members need to know.\u003c/p>\n\u003ch2>What rules have changed for health insurance companies?\u003c/h2>\n\u003cp>At the start of 2022, the federal government required insurers to reimburse their members for up to eight monthly at-home COVID-19 tests, regardless of where those tests were purchased. That federal rule lasted for over a year and ended in May 2023, when the federal state of emergency ended — but in California, state law extended it for six more months until Nov. 11.\u003c/p>\n\u003cp>Nov. 11 has come and gone, and there are some new rules to keep an eye out for.\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/news/11941075/californias-covid-emergency-ends-feb-28-what-does-that-actually-mean-for-you\">Insurers are \u003cem>still\u003c/em> required to reimburse members for up to eight at-home tests\u003c/a> as long as these tests are now obtained “in-network” with your insurer. However, other insurers will continue to reimburse you for tests regardless of where you buy them.\u003c/p>\n\u003cp>Of course, each insurance company does this a little differently — so make sure you know what’s available for you according to your plan before buying a test. And if you’re in any doubt, contact your insurer directly to find out what you’re eligible for \u003cem>before\u003c/em> you purchase any tests.\u003c/p>\n\u003ch2>How does my insurance company handle reimbursements for at-home COVID-19 tests?\u003c/h2>\n\u003cp>\u003cb>Kaiser Permanente\u003c/b>\u003c/p>\n\u003cp>Before Nov. 11, Kaiser Permanente members could buy at-home tests from any pharmacy or store and get reimbursed by completing a form. That process is no longer in place. Kaiser Permanente told KQED: “ If members get a COVID-19 vaccine, testing, or drug therapy outside of Kaiser Permanente after Nov. 11, they’ll be responsible for cost-sharing.”\u003c/p>\n\u003cp>Members, however, can receive up to eight home tests per month at no cost when they go to a Kaiser Permanente pharmacy. You can also order your eight tests online through the member services website, \u003ca href=\"https://healthy.kaiserpermanente.org/northern-california/front-door\">kp.org\u003c/a>.\u003c/p>\n\u003cp>One thing to keep in mind: If you order your tests through kp. org, you are not guaranteed a reimbursement. Kaiser Permanente told KQED that tests ordered through kp.org are “low cost” and members “may be eligible for reimbursement, depending on their plan.” For this reason, it may be worth contacting Kaiser’s membership services (as listed on your insurance card) to double-check your tests \u003cem>will\u003c/em> be free when ordered online.\u003c/p>\n\u003cp>The eight monthly tests are available to each Kaiser member, regardless of age. So if you, your spouse and two children are all covered by Kaiser Permanente, you can order up to 32 home tests each month through kp.org.\u003c/p>\n\u003cp>\u003cb>Blue Shield of California\u003c/b>\u003c/p>\n\u003cp>Blue Shield continues to fully reimburse policyholders for the cost of up to eight at-home tests each month. “Nothing regarding in-home COVID-19 testing has changed since Nov. 12,” the insurer told KQED.\u003c/p>\n\u003cp>Members can also buy home tests from anywhere. Unlike other insurance companies, Blue Shield does not have a network of preferred home test brands or providers. Once a member purchases their tests, \u003ca href=\"https://www.blueshieldca.com/bsca/bsc/public/common/PortalComponents/sites/StreamDocumentServlet?fileName=SITES_Other_2022_COVID%20Test%20Claim%20Form_v1_12232021.pdf\">they must complete a reimbursement claim form\u003c/a> and mail it to Blue Shield.[aside label='More Guides from KQED' tag='audience-news']Keep in mind that Blue Shield will only cover the cost of up to eight tests per month, max. You will not be reimbursed for the ninth test if you buy nine tests in one month. And if you are looking to get an in-person COVID-19 test done, for that, you \u003ci>will\u003c/i> have to go to an in-network provider so the cost of the test is covered.\u003c/p>\n\u003cp>\u003cb>Anthem Blue Cross\u003c/b>\u003c/p>\n\u003cp>Anthem Blue Cross has confirmed with KQED that it will continue to reimburse members with certain plans for at-home tests. You can buy the tests from any seller and are not limited to a specific network of test providers.\u003c/p>\n\u003cp>Keep in mind that there are some plans that do not qualify for reimbursements and based on the information that Anthem Blue Cross provided KQED, it seems that a member will only know if they qualify once they have filed a reimbursement claim.\u003c/p>\n\u003cp>To file a claim, first, make sure you still have the receipts from when you bought the tests because you will need to submit them later on. If you got the tests online, say through Amazon, you can find an electronic receipt when you go to your purchasing history. Once you have your receipts secured, \u003ca href=\"https://www.anthem.com/ca/login/?dplid=sso.dpl.rcp.member%2Fclaim-form\">head over to the Anthem Blue Cross member website\u003c/a>. If you use the SydneySM Health app, you can use that too.\u003c/p>\n\u003cp>Once you’ve logged in, click on “Claims” and select “Submit a Claim,” and that’s where you will complete an electronic form with all the details from your purchase.\u003c/p>\n\u003cp>And remember that in California, this insurer goes by \u003cstrong>Anthem Blue Cross\u003c/strong>, and in other states, it is called \u003cstrong>Anthem Blue Cross and Blue Shield\u003c/strong>. Distinguishing between the two is especially important to make sure you get the right benefits that correspond to your insurance plan. For example, \u003cstrong>Anthem Blue Cross and Blue Shield\u003c/strong> are no longer reimbursing members for at-home COVID-19 tests in other states, but \u003cstrong>Anthem Blue Cross\u003c/strong>, as explained above, is still covering members in California for these tests.\u003c/p>\n\u003cp>\u003cb>Aetna\u003c/b>\u003c/p>\n\u003cp>Aetna continues to cover the costs of up to eight at-home COVID-19 tests per month. This includes members with Aetna coverage through their employer and those on Medi-Cal.\u003c/p>\n\u003cp>To get reimbursed, policyholders should \u003ca href=\"https://member.aetna.com/MbrLanding/RoutingServlet?createSession=true&custNumSel=A&serviceName=home&ae_ptparam_cmpId=int_aetnaco\">log into Aetna’s member website\u003c/a> using their insurance plan credentials. Once logged in, click on “Submit a claim for reimbursement.” You’ll then see an electronic form that asks you for certain information, including the location and date of your purchase and a photo or scan of the receipt to verify your purchase.\u003c/p>\n\u003cp>If you are on a commercial plan and have Pharmacy Benefit coverage, there is a list of pharmacies that Aetna considers “in-network.” To make sure you get a reimbursement for the tests you buy, it’s probably best to buy them at an in-network pharmacy. If you receive Aetna coverage through Medi-Cal, you can buy tests from anywhere, regardless if the seller is in-network or not.\u003c/p>\n\u003cp>One last thing to keep in mind: Aetna members can currently request reimbursement through an online form. But that option will be discontinued at the end of this year. In 2024, the insurer says that you will need to call Member Services directly to request a reimbursement over the phone.\u003c/p>\n\u003cp>\u003cb>UnitedHealthcare and Cigna\u003c/b>\u003c/p>\n\u003cp>KQED has repeatedly reached out to UnitedHealthcare and Cigna but has not received an answer from either insurer’s media team. We’ll be updating this story once we have new information.\u003c/p>\n\u003ch2>What if I don’t have health insurance?\u003c/h2>\n\u003cp>Remember, you don’t need health insurance to order four free at-home COVID-19 tests online from the federal government. \u003ca href=\"https://www.kqed.org/news/11940562/how-to-find-a-free-covid-test-near-you-in-2023-because-its-getting-harder\">Read more about how to order four free tests per residential address via USPS.\u003c/a>\u003c/p>\n\u003cp>If you or someone in your community doesn’t have access to the internet to order these free tests, USPS says you can contact their helpline by calling 1-800-232-0233 (TTY 1-888-720-7489). You should also be prepared for potentially long wait times using this helpline.\u003c/p>\n\u003cp>Other ways of finding a free or low-cost COVID-19 test may still be available, using the CDC’s No-Cost Testing Locator or through your Bay Area county. These tests may be antigen tests or PCR tests. \u003ca href=\"https://www.kqed.org/news/11940562/how-to-find-a-free-covid-test-near-you-in-2023-because-its-getting-harder#findtests\">Read more about where to find a free or low-cost test near you.\u003c/a>\u003c/p>\n\u003cp>\u003cem>KQED’s Carly Severn contributed to this story.\u003c/em>\u003c/p>\n\u003ch2>\u003ca id=\"tellus\">\u003c/a>Tell us: What else do you need information about?\u003c/h2>\n\u003cp>At KQED News, we know that it can sometimes be hard to track down the answers to navigate life in the Bay Area in 2023. We’ve published \u003ca href=\"https://www.kqed.org/news/tag/coronavirus-resources-and-explainers\">clear, helpful explainers and guides about issues like COVID-19\u003c/a>, \u003ca href=\"https://www.kqed.org/news/11936674/how-to-prepare-for-this-weeks-atmospheric-river-storm-sandbags-emergency-kits-and-more\">how to cope with intense winter weather\u003c/a>, and \u003ca href=\"https://www.kqed.org/news/11821950/how-to-safely-attend-a-protest-in-the-bay-area\">how to exercise your right to protest safely\u003c/a>.\u003c/p>\n\u003cp>So tell us: What do you need to know more about? Tell us, and you could see your question answered online or on social media. What you submit will make our reporting stronger and help us decide what to cover here on our site and on KQED Public Radio, too.\u003c/p>\n\u003cp>[hearken id=\"10483\" src=\"https://modules.wearehearken.com/kqed/embed/10483.js\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"With COVID-19 infections on the rise, KQED spoke to health insurance companies about what they're doing in California and how to get reimbursed for at-home test kits in 2023.\r\n","status":"publish","parent":0,"modified":1702508652,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":true,"hasPolis":false,"paragraphCount":40,"wordCount":1794},"headData":{"title":"How to Get Reimbursed for At-Home COVID Tests This Winter | KQED","description":"With COVID-19 infections on the rise, KQED spoke to health insurance companies about what they're doing in California and how to get reimbursed for at-home test kits in 2023.\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"sticky":false,"excludeFromSiteSearch":"Include","articleAge":"0","path":"/news/11969300/how-to-get-reimbursed-for-at-home-covid-tests-in-2023","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Updated 1:30 p.m. Wednesday\u003c/em>\u003c/p>\n\u003cp>Winter in California has begun with foggy mornings, rainy nights and planning holiday dinners with family and friends. And like the past few winters, we’re also seeing COVID-19 infections creep back up across the state despite less free and easily accessible testing sites.\u003c/p>\n\u003cp>In early November, 6.2% of the PCR tests for COVID-19 administered in California came back positive, \u003ca href=\"https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Respiratory-Viruses/RespiratoryDashboard.aspx\">according to the state’s most recent data showing the seven-day average of those positivity rates.\u003c/a> One month later, the state’s most recent data from Dec. 4 shows that this rate has climbed to 8.8%.\u003c/p>\n\u003cp>The rate of positive COVID-19 tests has increased every winter since the start of the pandemic. In January 2022, the infection rate surpassed 20%, partly due to the spread of the powerful omicron variant. During that time, one out of every five tests administered in the state came back positive.\u003c/p>\n\u003cp>Even if you’re up to date with your vaccines and have \u003ca href=\"https://www.kqed.org/news/11960630/free-new-covid-vaccine-near-me-2023\">received the new updated COVID-19 vaccine\u003c/a>, it’s perfectly normal to feel still anxious about the coronavirus, especially if you plan to spend time with family and friends during the holiday season. On Nov. 30, public health officials from all nine Bay Area counties \u003ca href=\"https://sf.gov/news/respiratory-viruses-circulating-all-bay-area-health-officers-recommend-actions-stay-healthy\">published a list of recommendations to prevent respiratory infections\u003c/a> (COVID-19, RSV and the flu) during the holidays. Among these recommendations is stocking up on at-home COVID-19 tests.\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11940562","hero":"https://ww2.kqed.org/app/uploads/sites/10/2023/02/RS62644_GettyImages-1237599780-qut-1020x680.jpg","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>The federal government is still \u003ca href=\"https://www.kqed.org/news/11940562/how-to-find-a-free-covid-test-near-you-in-2023-because-its-getting-harder\">giving out four free COVID-19 tests to every household\u003c/a>. And yes, for many families four tests may just not be enough, especially considering that the high season for COVID-19 infections lasts several months. However, many insurance companies in California will still reimburse you for at-home tests you buy at the store or pharmacy.\u003c/p>\n\u003cp>The process of reimbursing for at-home COVID-19 tests \u003ca href=\"https://www.latimes.com/california/story/2023-02-07/with-covid-emergency-ending-will-i-have-to-pay-for-tests\">has changed in the last month\u003c/a>, and each insurer is reimbursing members differently. KQED reached out to every major health insurance company in California to learn what they’re doing and what members need to know.\u003c/p>\n\u003ch2>What rules have changed for health insurance companies?\u003c/h2>\n\u003cp>At the start of 2022, the federal government required insurers to reimburse their members for up to eight monthly at-home COVID-19 tests, regardless of where those tests were purchased. That federal rule lasted for over a year and ended in May 2023, when the federal state of emergency ended — but in California, state law extended it for six more months until Nov. 11.\u003c/p>\n\u003cp>Nov. 11 has come and gone, and there are some new rules to keep an eye out for.\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/news/11941075/californias-covid-emergency-ends-feb-28-what-does-that-actually-mean-for-you\">Insurers are \u003cem>still\u003c/em> required to reimburse members for up to eight at-home tests\u003c/a> as long as these tests are now obtained “in-network” with your insurer. However, other insurers will continue to reimburse you for tests regardless of where you buy them.\u003c/p>\n\u003cp>Of course, each insurance company does this a little differently — so make sure you know what’s available for you according to your plan before buying a test. And if you’re in any doubt, contact your insurer directly to find out what you’re eligible for \u003cem>before\u003c/em> you purchase any tests.\u003c/p>\n\u003ch2>How does my insurance company handle reimbursements for at-home COVID-19 tests?\u003c/h2>\n\u003cp>\u003cb>Kaiser Permanente\u003c/b>\u003c/p>\n\u003cp>Before Nov. 11, Kaiser Permanente members could buy at-home tests from any pharmacy or store and get reimbursed by completing a form. That process is no longer in place. Kaiser Permanente told KQED: “ If members get a COVID-19 vaccine, testing, or drug therapy outside of Kaiser Permanente after Nov. 11, they’ll be responsible for cost-sharing.”\u003c/p>\n\u003cp>Members, however, can receive up to eight home tests per month at no cost when they go to a Kaiser Permanente pharmacy. You can also order your eight tests online through the member services website, \u003ca href=\"https://healthy.kaiserpermanente.org/northern-california/front-door\">kp.org\u003c/a>.\u003c/p>\n\u003cp>One thing to keep in mind: If you order your tests through kp. org, you are not guaranteed a reimbursement. Kaiser Permanente told KQED that tests ordered through kp.org are “low cost” and members “may be eligible for reimbursement, depending on their plan.” For this reason, it may be worth contacting Kaiser’s membership services (as listed on your insurance card) to double-check your tests \u003cem>will\u003c/em> be free when ordered online.\u003c/p>\n\u003cp>The eight monthly tests are available to each Kaiser member, regardless of age. So if you, your spouse and two children are all covered by Kaiser Permanente, you can order up to 32 home tests each month through kp.org.\u003c/p>\n\u003cp>\u003cb>Blue Shield of California\u003c/b>\u003c/p>\n\u003cp>Blue Shield continues to fully reimburse policyholders for the cost of up to eight at-home tests each month. “Nothing regarding in-home COVID-19 testing has changed since Nov. 12,” the insurer told KQED.\u003c/p>\n\u003cp>Members can also buy home tests from anywhere. Unlike other insurance companies, Blue Shield does not have a network of preferred home test brands or providers. Once a member purchases their tests, \u003ca href=\"https://www.blueshieldca.com/bsca/bsc/public/common/PortalComponents/sites/StreamDocumentServlet?fileName=SITES_Other_2022_COVID%20Test%20Claim%20Form_v1_12232021.pdf\">they must complete a reimbursement claim form\u003c/a> and mail it to Blue Shield.\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"label":"More Guides from KQED ","tag":"audience-news"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Keep in mind that Blue Shield will only cover the cost of up to eight tests per month, max. You will not be reimbursed for the ninth test if you buy nine tests in one month. And if you are looking to get an in-person COVID-19 test done, for that, you \u003ci>will\u003c/i> have to go to an in-network provider so the cost of the test is covered.\u003c/p>\n\u003cp>\u003cb>Anthem Blue Cross\u003c/b>\u003c/p>\n\u003cp>Anthem Blue Cross has confirmed with KQED that it will continue to reimburse members with certain plans for at-home tests. You can buy the tests from any seller and are not limited to a specific network of test providers.\u003c/p>\n\u003cp>Keep in mind that there are some plans that do not qualify for reimbursements and based on the information that Anthem Blue Cross provided KQED, it seems that a member will only know if they qualify once they have filed a reimbursement claim.\u003c/p>\n\u003cp>To file a claim, first, make sure you still have the receipts from when you bought the tests because you will need to submit them later on. If you got the tests online, say through Amazon, you can find an electronic receipt when you go to your purchasing history. Once you have your receipts secured, \u003ca href=\"https://www.anthem.com/ca/login/?dplid=sso.dpl.rcp.member%2Fclaim-form\">head over to the Anthem Blue Cross member website\u003c/a>. If you use the SydneySM Health app, you can use that too.\u003c/p>\n\u003cp>Once you’ve logged in, click on “Claims” and select “Submit a Claim,” and that’s where you will complete an electronic form with all the details from your purchase.\u003c/p>\n\u003cp>And remember that in California, this insurer goes by \u003cstrong>Anthem Blue Cross\u003c/strong>, and in other states, it is called \u003cstrong>Anthem Blue Cross and Blue Shield\u003c/strong>. Distinguishing between the two is especially important to make sure you get the right benefits that correspond to your insurance plan. For example, \u003cstrong>Anthem Blue Cross and Blue Shield\u003c/strong> are no longer reimbursing members for at-home COVID-19 tests in other states, but \u003cstrong>Anthem Blue Cross\u003c/strong>, as explained above, is still covering members in California for these tests.\u003c/p>\n\u003cp>\u003cb>Aetna\u003c/b>\u003c/p>\n\u003cp>Aetna continues to cover the costs of up to eight at-home COVID-19 tests per month. This includes members with Aetna coverage through their employer and those on Medi-Cal.\u003c/p>\n\u003cp>To get reimbursed, policyholders should \u003ca href=\"https://member.aetna.com/MbrLanding/RoutingServlet?createSession=true&custNumSel=A&serviceName=home&ae_ptparam_cmpId=int_aetnaco\">log into Aetna’s member website\u003c/a> using their insurance plan credentials. Once logged in, click on “Submit a claim for reimbursement.” You’ll then see an electronic form that asks you for certain information, including the location and date of your purchase and a photo or scan of the receipt to verify your purchase.\u003c/p>\n\u003cp>If you are on a commercial plan and have Pharmacy Benefit coverage, there is a list of pharmacies that Aetna considers “in-network.” To make sure you get a reimbursement for the tests you buy, it’s probably best to buy them at an in-network pharmacy. If you receive Aetna coverage through Medi-Cal, you can buy tests from anywhere, regardless if the seller is in-network or not.\u003c/p>\n\u003cp>One last thing to keep in mind: Aetna members can currently request reimbursement through an online form. But that option will be discontinued at the end of this year. In 2024, the insurer says that you will need to call Member Services directly to request a reimbursement over the phone.\u003c/p>\n\u003cp>\u003cb>UnitedHealthcare and Cigna\u003c/b>\u003c/p>\n\u003cp>KQED has repeatedly reached out to UnitedHealthcare and Cigna but has not received an answer from either insurer’s media team. We’ll be updating this story once we have new information.\u003c/p>\n\u003ch2>What if I don’t have health insurance?\u003c/h2>\n\u003cp>Remember, you don’t need health insurance to order four free at-home COVID-19 tests online from the federal government. \u003ca href=\"https://www.kqed.org/news/11940562/how-to-find-a-free-covid-test-near-you-in-2023-because-its-getting-harder\">Read more about how to order four free tests per residential address via USPS.\u003c/a>\u003c/p>\n\u003cp>If you or someone in your community doesn’t have access to the internet to order these free tests, USPS says you can contact their helpline by calling 1-800-232-0233 (TTY 1-888-720-7489). You should also be prepared for potentially long wait times using this helpline.\u003c/p>\n\u003cp>Other ways of finding a free or low-cost COVID-19 test may still be available, using the CDC’s No-Cost Testing Locator or through your Bay Area county. These tests may be antigen tests or PCR tests. \u003ca href=\"https://www.kqed.org/news/11940562/how-to-find-a-free-covid-test-near-you-in-2023-because-its-getting-harder#findtests\">Read more about where to find a free or low-cost test near you.\u003c/a>\u003c/p>\n\u003cp>\u003cem>KQED’s Carly Severn contributed to this story.\u003c/em>\u003c/p>\n\u003ch2>\u003ca id=\"tellus\">\u003c/a>Tell us: What else do you need information about?\u003c/h2>\n\u003cp>At KQED News, we know that it can sometimes be hard to track down the answers to navigate life in the Bay Area in 2023. We’ve published \u003ca href=\"https://www.kqed.org/news/tag/coronavirus-resources-and-explainers\">clear, helpful explainers and guides about issues like COVID-19\u003c/a>, \u003ca href=\"https://www.kqed.org/news/11936674/how-to-prepare-for-this-weeks-atmospheric-river-storm-sandbags-emergency-kits-and-more\">how to cope with intense winter weather\u003c/a>, and \u003ca href=\"https://www.kqed.org/news/11821950/how-to-safely-attend-a-protest-in-the-bay-area\">how to exercise your right to protest safely\u003c/a>.\u003c/p>\n\u003cp>So tell us: What do you need to know more about? Tell us, and you could see your question answered online or on social media. What you submit will make our reporting stronger and help us decide what to cover here on our site and on KQED Public Radio, too.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"hearken","attributes":{"named":{"id":"10483","src":"https://modules.wearehearken.com/kqed/embed/10483.js","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11969300/how-to-get-reimbursed-for-at-home-covid-tests-in-2023","authors":["11708"],"categories":["news_457","news_8"],"tags":["news_32707","news_27350","news_27989","news_30457","news_27504","news_29122","news_27626","news_1054"],"featImg":"news_11926460","label":"news"},"news_11961980":{"type":"posts","id":"news_11961980","meta":{"index":"posts_1591205157","site":"news","id":"11961980","score":null,"sort":[1695294018000]},"guestAuthors":[],"slug":"what-to-do-if-youre-one-of-the-thousands-of-californians-losing-medi-cal-coverage-every-month","title":"What to Do if You're One of the Thousands of Californians Losing Medi-Cal Coverage Every Month","publishDate":1695294018,"format":"standard","headTitle":"What to Do if You’re One of the Thousands of Californians Losing Medi-Cal Coverage Every Month | KQED","labelTerm":{"term":18481,"site":"news"},"content":"\u003cp>\u003cem>Lea este artículo en \u003ca href=\"https://calmatters.org/calmatters-en-espanol/2023/09/miles-de-californianos-pierden-medi-cal-cada-mes-que-puede-hacer-si-pierde-la-cobertura/\">español\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>Tens of thousands of Californians are losing health insurance every month as the state resumes checking people’s eligibility for Medi-Cal, which it suspended during the COVID-19 public health emergency.\u003c/p>\n\u003cp>About 16 million people in California will be evaluated for eligibility from June 2023 to May 2024. About half of those up for a review were automatically renewed because officials were able to verify their information in the system. Others were sent yellow renewal packets that they were supposed to fill out and send back to their county Medi-Cal office.\u003c/p>\n\u003cp>More than 300,000 Californians have lost their Medi-Cal eligibility since July 1. The majority of lost coverage in June and July was due to procedural reasons, such as not sending their renewal forms back or having \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/Pages/Continuous-Coverage-Eligibility-Unwinding-Dashboard.aspx\">incorrect information in their forms\u003c/a>, according to state data.\u003c/p>\n\u003cp>Some people losing coverage are no longer eligible because of changes in their personal lives, such as starting a job with higher pay. But some might see their coverage lapse because of paperwork mistakes or simply missing a notice in the mail.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s because it’s been such a long period where folks have not had to renew their health coverage,” said Cary Sanders, senior policy director at the California Pan-Ethnic Health Network. “There could be up to 2 to 3 million Californians who could lose their health coverage just by virtue of this change, because there would be people who wouldn’t know what to do.”\u003c/p>\n\u003cp>Here are some answers to questions about what you can do if you lose coverage, including how to appeal.\u003c/p>\n\u003ch2>How do I know if I got disenrolled from Medi-Cal?\u003c/h2>\n\u003cp>You will get notified through mail. If you didn’t receive a notification but still believe you might have lost coverage, you can call your local Medi-Cal office to check eligibility or go to your regular clinic or hospital where they can look this information up for you.\u003c/p>\n\u003cp>For any questions about Medi-Cal eligibility, you can contact the state \u003ca href=\"https://www.dhcs.ca.gov/\">Department of Health Care Services\u003c/a>, which manages the Medi-Cal program. Its \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-Cal%20Eligibility%20Division.aspx\">Medi-Cal Eligibility Division\u003c/a> can be contacted at (916) 552-9200.\u003c/p>\n\u003ch2>I qualify for Medi-Cal but still got disenrolled. What should I do?\u003c/h2>\n\u003cp>Your next step depends on how much time has lapsed since you lost your coverage, as stated on the official notification letter.\u003c/p>\n\u003cp>[aside postID=news_11944543 hero='https://ww2.kqed.org/app/uploads/sites/10/2023/03/pexels-thirdman-5327584.jpg']The state has instituted a 90-day appeal period in case you lost coverage even though you qualify.\u003c/p>\n\u003cp>If you are within the 90-day period, you should immediately fill out the yellow renewal packet, or supply any missing information, and send it to your county Medi-Cal office. If you lost the packet or sent the packet but still got disenrolled, call your local Medi-Cal office or go to your regular clinic or hospital to figure out the next steps.\u003c/p>\n\u003cp>If you are unable to send your information to your local Medi-Cal office due to accessibility issues and are running out of time, ask the office staff to accept your documents electronically or through the phone.\u003c/p>\n\u003cp>If you are past the 90-day period, you will be required to reapply for Medi-Cal benefits. This means starting a new application entirely.\u003c/p>\n\u003ch2>How can I appeal?\u003c/h2>\n\u003cp>Tatiana Fassieux, training and education specialist at Medicare advocacy nonprofit California Health Advocates, said people should remember that they have rights to appeal.\u003c/p>\n\u003cp>If you received a notification about disenrollment, you can request \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/Pages/Medi-CalFairHearing.aspx\">a Fair Hearing\u003c/a> and appeal the loss of coverage. This will ensure that your benefits continue until the hearing is resolved.\u003c/p>\n\u003cp>“Many people take the letter verbatim and they don’t read it and they don’t appeal,” she said.\u003c/p>\n\u003cp>According to the state Department of Health Care Services, adults under the age of 26 or over age 50 can qualify for Medi-Cal regardless of immigration status. Medi-Cal does not share information with the immigration office, so undocumented Californians should not be afraid to seek help. Starting Jan. 1. Californians of all ages will be able to qualify for Medi-Cal irrespective of immigration status.\u003c/p>\n\u003ch2>I got disenrolled because I no longer qualify. How can I get health insurance?\u003c/h2>\n\u003cp>If you no longer qualify for Medi-Cal, you may still be able to get low-cost health insurance through \u003ca href=\"https://www.coveredca.com/\">Covered California,\u003c/a> which is the state’s marketplace for health insurance plans.\u003c/p>\n\u003cp>[aside postID=news_11942493]Those who earn up to 250% of the federal poverty level — or $33,975 for an individual or $69,375 for a family of four — would qualify for low-premium plans through Covered California. You may also be eligible for additional health insurance subsidies through \u003ca href=\"https://www.healthforcalifornia.com/covered-california?gclid=CjwKCAjwu4WoBhBkEiwAojNdXjuBHyXGv9QJ2WvwCQzjCMswHa1vsR1UuxKuTWc4ZI-l4ObZEcUNSxoCbQsQAvD_BwE\">the Affordable Care Act (ACA)\u003c/a>, including \u003ca href=\"https://www.irs.gov/affordable-care-act/individuals-and-families/the-premium-tax-credit-the-basics\">the Advance Premium Tax Credit\u003c/a> and \u003ca href=\"https://www.healthforcalifornia.com/covered-california/cost-sharing?gclid=CjwKCAjwu4WoBhBkEiwAojNdXm8haH2iO9JNelTbsVelQiCRS6uKUAGaOnFPfnOXFmDtuJX4TuxvahoCL8IQAvD_BwE\">Cost-Sharing Reduction plans\u003c/a>.\u003c/p>\n\u003cp>If you are over the age of 65 or have disabilities, you may also qualify for \u003ca href=\"https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare\">Medicare\u003c/a> (in addition), which can help pay for hospital costs, medical care and even prescription medication.\u003c/p>\n\u003ch2>How can I make sure I don’t get disenrolled in the future?\u003c/h2>\n\u003cp>Keep an eye out for any mail sent to you from your county Medi-Cal office. If you recently moved, make sure to update your address on the Medi-Cal website or by calling your local office.\u003c/p>\n\u003cp>You will be expected to renew and update your Medi-Cal coverage every year, so keep all your important information in an accessible place.\u003c/p>\n\u003cp>“You should have your documents like tax returns and health records handy,” Fassieux said.\u003c/p>\n\u003cp>You can \u003ca href=\"https://www.dhcs.ca.gov/pages/keep-your-medi-cal.aspx?utm_source=keepmedicalcoverage.org&utm_medium=referral&utm_campaign=keep-mc-coverage\">sign up\u003c/a> for renewal reminders through the state’s renewal website: keepmedicalcoverage.org. That resource also is \u003ca href=\"https://www.dhcs.ca.gov/Pages/mantenga-su-medi-cal.aspx\">available from the state in Spanish\u003c/a>.\u003c/p>\n\u003ch2>Are there any other resources I can use for help?\u003c/h2>\n\u003cp>The state’s Department of Health Care Services has several resources to help, including \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx\">contact information for your local Medi-Cal office\u003c/a>, schedules of \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Partner-Community-Events.aspx\">community events and health fairs\u003c/a> where you can get information in person, and guides on \u003ca href=\"https://www.dhcs.ca.gov/pages/keep-your-medi-cal.aspx\">what to do if you lost Medi-Cal coverage\u003c/a>.\u003c/p>\n\u003cp>For assistance with Medi-Cal re-enrollment, you also can call the Office of the Medi-Cal Ombudsman. The office is a neutral resource that can help you deal with any issues you may have with the program. You can contact \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/Pages/MMCDOfficeoftheOmbudsman.aspx\">the Office of the Ombudsman\u003c/a> at (888) 452-8609.\u003c/p>\n\u003cp>There are also several third-party services that can help you get back on Medi-Cal.\u003c/p>\n\u003cp>\u003ca href=\"https://healthconsumer.org/\">Health Consumer Alliance\u003c/a> is a free assistance program funded by The California Endowment, Covered California, the state Department of Managed Health Care and the Blue Shield Foundation. It provides legal services and can help you renew your Medi-Cal coverage. To get in touch, you can read \u003ca href=\"https://healthconsumer.org/covid19/\">their guide on renewing Medi-Cal\u003c/a> or call their toll-free number, 888‑804‑3536.\u003c/p>\n\u003cp>You can contact \u003ca href=\"https://benefitscal.com/\">BenefitsCal\u003c/a> which also provides assistance with Medi-Cal. The website has translations in 20 languages.\u003c/p>\n\u003ch2>Will seniors and other vulnerable populations get special assistance?\u003c/h2>\n\u003cp>According to health policy organization \u003ca href=\"https://justiceinaging.org/\">Justice in Aging\u003c/a>, seniors and those with disabilities have experienced higher rates of disenrollment from Medi-Cal. \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/Pages/Continuous-Coverage-Eligibility-Unwinding-Dashboard.aspx\">Seniors, pregnant women, and certain children under 21\u003c/a> experienced a disenrollment rate of 26.7% in June 2023, compared to the overall average rate of 21%, according to the Department of Health Care Services.\u003c/p>\n\u003cp>Tiffany Huyenh-Cho, a health attorney at Justice in Aging, said seniors and people with disabilities are dual-eligible, which means they qualify for both Medicare and Medi-Cal.\u003c/p>\n\u003cp>“Dual-eligibles are a very diverse group with really high chronic needs, and they are more likely to be a person of color,” she said. “Their health disparities and chronic conditions are exacerbated by the loss of Medicaid.”\u003c/p>\n\u003cp>Often seniors and other dual-eligibles use their Medi-Cal benefits to cover their Medicare premiums as well as any wraparound services not included in Medicare. The loss of Medi-Cal means they may lose these additional benefits and face the deduction of Medicare premiums from their Social Security checks, said Huyenh-Cho.\u003c/p>\n\u003cp>“That puts people at risk of not being able to pay for rent and other needs, like clothing, food and utilities,” she said. “One of the big concerns that we have is it puts people at risk of economic insecurity and potentially at risk of homelessness because of that loss of income.”\u003c/p>\n\u003cp>Those who require additional assistance can reach out to \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/NavigatorsProject.aspx\">state-supported enrollment navigators\u003c/a>, which are community-based organizations and social service agencies that help vulnerable populations through the process.\u003c/p>\n\u003cp>The Department of Health Care Services has also released \u003ca href=\"https://socialpresskit.com/keep-medi-cal-coverage\">a social media toolkit\u003c/a> to spread awareness about redeterminations, so people can renew their coverage before they get disenrolled. This kit is available in 19 languages.\u003c/p>\n\u003cp>\u003cem>Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit \u003ca href=\"https://www.chcf.org/\">www.chcf.org\u003c/a> to learn more.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"About 300,000 Californians have lost Medi-Cal coverage since the state resumed eligibility checks. ","status":"publish","parent":0,"modified":1695254411,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":40,"wordCount":1547},"headData":{"title":"What to Do if You're One of the Thousands of Californians Losing Medi-Cal Coverage Every Month | KQED","description":"About 300,000 Californians have lost Medi-Cal coverage since the state resumed eligibility checks. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"nprByline":"\u003ca href=\"https://calmatters.org/author/shreya-agrawal/\">Shreya Agrawal\u003c/a>","excludeFromSiteSearch":"Include","showOnAuthorArchivePages":"No","articleAge":"0","path":"/news/11961980/what-to-do-if-youre-one-of-the-thousands-of-californians-losing-medi-cal-coverage-every-month","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Lea este artículo en \u003ca href=\"https://calmatters.org/calmatters-en-espanol/2023/09/miles-de-californianos-pierden-medi-cal-cada-mes-que-puede-hacer-si-pierde-la-cobertura/\">español\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>Tens of thousands of Californians are losing health insurance every month as the state resumes checking people’s eligibility for Medi-Cal, which it suspended during the COVID-19 public health emergency.\u003c/p>\n\u003cp>About 16 million people in California will be evaluated for eligibility from June 2023 to May 2024. About half of those up for a review were automatically renewed because officials were able to verify their information in the system. Others were sent yellow renewal packets that they were supposed to fill out and send back to their county Medi-Cal office.\u003c/p>\n\u003cp>More than 300,000 Californians have lost their Medi-Cal eligibility since July 1. The majority of lost coverage in June and July was due to procedural reasons, such as not sending their renewal forms back or having \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/Pages/Continuous-Coverage-Eligibility-Unwinding-Dashboard.aspx\">incorrect information in their forms\u003c/a>, according to state data.\u003c/p>\n\u003cp>Some people losing coverage are no longer eligible because of changes in their personal lives, such as starting a job with higher pay. But some might see their coverage lapse because of paperwork mistakes or simply missing a notice in the mail.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s because it’s been such a long period where folks have not had to renew their health coverage,” said Cary Sanders, senior policy director at the California Pan-Ethnic Health Network. “There could be up to 2 to 3 million Californians who could lose their health coverage just by virtue of this change, because there would be people who wouldn’t know what to do.”\u003c/p>\n\u003cp>Here are some answers to questions about what you can do if you lose coverage, including how to appeal.\u003c/p>\n\u003ch2>How do I know if I got disenrolled from Medi-Cal?\u003c/h2>\n\u003cp>You will get notified through mail. If you didn’t receive a notification but still believe you might have lost coverage, you can call your local Medi-Cal office to check eligibility or go to your regular clinic or hospital where they can look this information up for you.\u003c/p>\n\u003cp>For any questions about Medi-Cal eligibility, you can contact the state \u003ca href=\"https://www.dhcs.ca.gov/\">Department of Health Care Services\u003c/a>, which manages the Medi-Cal program. Its \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-Cal%20Eligibility%20Division.aspx\">Medi-Cal Eligibility Division\u003c/a> can be contacted at (916) 552-9200.\u003c/p>\n\u003ch2>I qualify for Medi-Cal but still got disenrolled. What should I do?\u003c/h2>\n\u003cp>Your next step depends on how much time has lapsed since you lost your coverage, as stated on the official notification letter.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11944543","hero":"https://ww2.kqed.org/app/uploads/sites/10/2023/03/pexels-thirdman-5327584.jpg","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>The state has instituted a 90-day appeal period in case you lost coverage even though you qualify.\u003c/p>\n\u003cp>If you are within the 90-day period, you should immediately fill out the yellow renewal packet, or supply any missing information, and send it to your county Medi-Cal office. If you lost the packet or sent the packet but still got disenrolled, call your local Medi-Cal office or go to your regular clinic or hospital to figure out the next steps.\u003c/p>\n\u003cp>If you are unable to send your information to your local Medi-Cal office due to accessibility issues and are running out of time, ask the office staff to accept your documents electronically or through the phone.\u003c/p>\n\u003cp>If you are past the 90-day period, you will be required to reapply for Medi-Cal benefits. This means starting a new application entirely.\u003c/p>\n\u003ch2>How can I appeal?\u003c/h2>\n\u003cp>Tatiana Fassieux, training and education specialist at Medicare advocacy nonprofit California Health Advocates, said people should remember that they have rights to appeal.\u003c/p>\n\u003cp>If you received a notification about disenrollment, you can request \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/Pages/Medi-CalFairHearing.aspx\">a Fair Hearing\u003c/a> and appeal the loss of coverage. This will ensure that your benefits continue until the hearing is resolved.\u003c/p>\n\u003cp>“Many people take the letter verbatim and they don’t read it and they don’t appeal,” she said.\u003c/p>\n\u003cp>According to the state Department of Health Care Services, adults under the age of 26 or over age 50 can qualify for Medi-Cal regardless of immigration status. Medi-Cal does not share information with the immigration office, so undocumented Californians should not be afraid to seek help. Starting Jan. 1. Californians of all ages will be able to qualify for Medi-Cal irrespective of immigration status.\u003c/p>\n\u003ch2>I got disenrolled because I no longer qualify. How can I get health insurance?\u003c/h2>\n\u003cp>If you no longer qualify for Medi-Cal, you may still be able to get low-cost health insurance through \u003ca href=\"https://www.coveredca.com/\">Covered California,\u003c/a> which is the state’s marketplace for health insurance plans.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11942493","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Those who earn up to 250% of the federal poverty level — or $33,975 for an individual or $69,375 for a family of four — would qualify for low-premium plans through Covered California. You may also be eligible for additional health insurance subsidies through \u003ca href=\"https://www.healthforcalifornia.com/covered-california?gclid=CjwKCAjwu4WoBhBkEiwAojNdXjuBHyXGv9QJ2WvwCQzjCMswHa1vsR1UuxKuTWc4ZI-l4ObZEcUNSxoCbQsQAvD_BwE\">the Affordable Care Act (ACA)\u003c/a>, including \u003ca href=\"https://www.irs.gov/affordable-care-act/individuals-and-families/the-premium-tax-credit-the-basics\">the Advance Premium Tax Credit\u003c/a> and \u003ca href=\"https://www.healthforcalifornia.com/covered-california/cost-sharing?gclid=CjwKCAjwu4WoBhBkEiwAojNdXm8haH2iO9JNelTbsVelQiCRS6uKUAGaOnFPfnOXFmDtuJX4TuxvahoCL8IQAvD_BwE\">Cost-Sharing Reduction plans\u003c/a>.\u003c/p>\n\u003cp>If you are over the age of 65 or have disabilities, you may also qualify for \u003ca href=\"https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare\">Medicare\u003c/a> (in addition), which can help pay for hospital costs, medical care and even prescription medication.\u003c/p>\n\u003ch2>How can I make sure I don’t get disenrolled in the future?\u003c/h2>\n\u003cp>Keep an eye out for any mail sent to you from your county Medi-Cal office. If you recently moved, make sure to update your address on the Medi-Cal website or by calling your local office.\u003c/p>\n\u003cp>You will be expected to renew and update your Medi-Cal coverage every year, so keep all your important information in an accessible place.\u003c/p>\n\u003cp>“You should have your documents like tax returns and health records handy,” Fassieux said.\u003c/p>\n\u003cp>You can \u003ca href=\"https://www.dhcs.ca.gov/pages/keep-your-medi-cal.aspx?utm_source=keepmedicalcoverage.org&utm_medium=referral&utm_campaign=keep-mc-coverage\">sign up\u003c/a> for renewal reminders through the state’s renewal website: keepmedicalcoverage.org. That resource also is \u003ca href=\"https://www.dhcs.ca.gov/Pages/mantenga-su-medi-cal.aspx\">available from the state in Spanish\u003c/a>.\u003c/p>\n\u003ch2>Are there any other resources I can use for help?\u003c/h2>\n\u003cp>The state’s Department of Health Care Services has several resources to help, including \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx\">contact information for your local Medi-Cal office\u003c/a>, schedules of \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Partner-Community-Events.aspx\">community events and health fairs\u003c/a> where you can get information in person, and guides on \u003ca href=\"https://www.dhcs.ca.gov/pages/keep-your-medi-cal.aspx\">what to do if you lost Medi-Cal coverage\u003c/a>.\u003c/p>\n\u003cp>For assistance with Medi-Cal re-enrollment, you also can call the Office of the Medi-Cal Ombudsman. The office is a neutral resource that can help you deal with any issues you may have with the program. You can contact \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/Pages/MMCDOfficeoftheOmbudsman.aspx\">the Office of the Ombudsman\u003c/a> at (888) 452-8609.\u003c/p>\n\u003cp>There are also several third-party services that can help you get back on Medi-Cal.\u003c/p>\n\u003cp>\u003ca href=\"https://healthconsumer.org/\">Health Consumer Alliance\u003c/a> is a free assistance program funded by The California Endowment, Covered California, the state Department of Managed Health Care and the Blue Shield Foundation. It provides legal services and can help you renew your Medi-Cal coverage. To get in touch, you can read \u003ca href=\"https://healthconsumer.org/covid19/\">their guide on renewing Medi-Cal\u003c/a> or call their toll-free number, 888‑804‑3536.\u003c/p>\n\u003cp>You can contact \u003ca href=\"https://benefitscal.com/\">BenefitsCal\u003c/a> which also provides assistance with Medi-Cal. The website has translations in 20 languages.\u003c/p>\n\u003ch2>Will seniors and other vulnerable populations get special assistance?\u003c/h2>\n\u003cp>According to health policy organization \u003ca href=\"https://justiceinaging.org/\">Justice in Aging\u003c/a>, seniors and those with disabilities have experienced higher rates of disenrollment from Medi-Cal. \u003ca href=\"https://www.dhcs.ca.gov/dataandstats/Pages/Continuous-Coverage-Eligibility-Unwinding-Dashboard.aspx\">Seniors, pregnant women, and certain children under 21\u003c/a> experienced a disenrollment rate of 26.7% in June 2023, compared to the overall average rate of 21%, according to the Department of Health Care Services.\u003c/p>\n\u003cp>Tiffany Huyenh-Cho, a health attorney at Justice in Aging, said seniors and people with disabilities are dual-eligible, which means they qualify for both Medicare and Medi-Cal.\u003c/p>\n\u003cp>“Dual-eligibles are a very diverse group with really high chronic needs, and they are more likely to be a person of color,” she said. “Their health disparities and chronic conditions are exacerbated by the loss of Medicaid.”\u003c/p>\n\u003cp>Often seniors and other dual-eligibles use their Medi-Cal benefits to cover their Medicare premiums as well as any wraparound services not included in Medicare. The loss of Medi-Cal means they may lose these additional benefits and face the deduction of Medicare premiums from their Social Security checks, said Huyenh-Cho.\u003c/p>\n\u003cp>“That puts people at risk of not being able to pay for rent and other needs, like clothing, food and utilities,” she said. “One of the big concerns that we have is it puts people at risk of economic insecurity and potentially at risk of homelessness because of that loss of income.”\u003c/p>\n\u003cp>Those who require additional assistance can reach out to \u003ca href=\"https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/NavigatorsProject.aspx\">state-supported enrollment navigators\u003c/a>, which are community-based organizations and social service agencies that help vulnerable populations through the process.\u003c/p>\n\u003cp>The Department of Health Care Services has also released \u003ca href=\"https://socialpresskit.com/keep-medi-cal-coverage\">a social media toolkit\u003c/a> to spread awareness about redeterminations, so people can renew their coverage before they get disenrolled. This kit is available in 19 languages.\u003c/p>\n\u003cp>\u003cem>Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit \u003ca href=\"https://www.chcf.org/\">www.chcf.org\u003c/a> to learn more.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11961980/what-to-do-if-youre-one-of-the-thousands-of-californians-losing-medi-cal-coverage-every-month","authors":["byline_news_11961980"],"categories":["news_457","news_8"],"tags":["news_32707","news_1054","news_26717"],"affiliates":["news_18481"],"featImg":"news_11961982","label":"news_18481"},"news_11956545":{"type":"posts","id":"news_11956545","meta":{"index":"posts_1591205157","site":"news","id":"11956545","score":null,"sort":[1690400113000]},"guestAuthors":[],"slug":"its-worrisome-covered-california-announces-biggest-increase-in-premiums","title":"'It's Worrisome': Covered California Announces Biggest Increase in Premiums","publishDate":1690400113,"format":"standard","headTitle":"‘It’s Worrisome’: Covered California Announces Biggest Increase in Premiums | KQED","labelTerm":{},"content":"\u003cp>Premiums for health insurance sold through the state marketplace will increase by nearly 10% next year, the highest rate hike since 2018, \u003ca href=\"https://www.coveredca.com/newsroom/news-releases/2023/07/25/\">Covered California officials announced\u003c/a> Tuesday.\u003c/p>\n\u003cp>The projected 9.6% hike is the result of a “complicated time for health care,” Covered California Executive Director Jessica Altman said during a media briefing, but many Californians will be shielded from the increases as a result of federal and state financial assistance.\u003c/p>\n\u003cp>About 90% of enrollees qualify for some type of federal or state financial aid and 20% will see no change in their monthly premium, officials said. About 1.6 million Californians turn to the marketplace for health insurance, which offers plans that cost as little as $10 a month.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The rate increase, however, represents the return of a troubling trend: \u003ca href=\"https://calmatters.org/health/2022/07/rising-health-care-costs/\">runaway health care costs\u003c/a>, experts said.\u003c/p>\n\u003cp>“We’re seeing even larger increases in the private market. It’s worrisome,” said Anthony Wright, executive director of Health Access California, a consumer advocate group. “Individual consumers need health coverage and they need help now.”[pullquote size=\"medium\" align=\"right\" citation=\"Anthony Wright, executive director, Health Access California\"]‘We’re seeing even larger increases in the private market. It’s worrisome. Individual consumers need health coverage and they need help now.’[/pullquote]During the COVID-19 pandemic, an influx of $3 billion from the federal government helped dampen the effect of rising health care costs in California. Covered California premium increases held below 2% between 2020 and 2022.\u003c/p>\n\u003cp>The federal government extended assistance for two more years, but the 2024 increase reflects post-pandemic inflationary pressures, such as \u003ca href=\"https://calmatters.org/health/2023/05/cost-of-insulin/\">higher drug costs\u003c/a>, more people going to see the doctor, labor shortages and wage costs, Altman said.\u003c/p>\n\u003cp>The rate hikes vary by region, with more than one-third of enrollees potentially experiencing a double-digit increase, according to state data. Those who live in Mono, Inyo and Imperial counties may see the largest price increase at 15.8% compared to last year. Those same counties also experienced the \u003ca href=\"https://calmatters.org/health/2022/07/covered-california-rates/\">largest increase last year\u003c/a>.\u003c/p>\n\u003cp>“We’re glad that Covered California has federal and state subsidies to provide immediate help now, but we do need policymakers to double down on containing the costs of health care long-term,” Wright said. “This is a clarion call for the overall cost of health care going forward.”\u003c/p>\n\u003ch2>Covered California waives deductibles for many\u003c/h2>\n\u003cp>Last week, the \u003ca href=\"https://calmatters.org/newsletters/whatmatters/2023/07/california-cost-of-living-3/#wm-story-1\">Covered California board voted\u003c/a> to implement a plan that will make coverage more affordable for about 650,000 enrollees by eliminating their deductibles for the coming year.[aside postID=news_11949192 hero='https://ww2.kqed.org/app/uploads/sites/10/2023/05/IMG_0196-1-1020x765.jpg']The vote capped a \u003ca href=\"https://calmatters.org/health/2023/05/covered-california-cost/\">drawn-out budget battle\u003c/a> between Gov. Gavin Newsom, legislators and health care consumer advocates who have \u003ca href=\"https://calmatters.org/health/2023/02/health-care-costs/\">criticized Newsom\u003c/a> for repeatedly moving money intended for health care subsidies into the state’s general fund.\u003c/p>\n\u003cp>Under the plan, deductibles will be eliminated for individuals earning as much as $33,975 annually and families earning up to $69,375 annually. Previously, people with those plans paid deductibles of up to $5,400. The new plan also significantly reduces out-of-pocket copays for doctor visits and prescription drugs.\u003c/p>\n\u003cp>“Despite the rate increase, Californians who enroll in health care coverage through Covered California will benefit from the greatest level of financial support ever offered … as we head into 2024,” Altman said.\u003c/p>\n\u003ch2>‘Hefty’ health insurance increase\u003c/h2>\n\u003cp>Christine Eibner, a senior economist with the RAND Corporation, a research and policy think tank, called the state’s projected premium increase “hefty.”[aside label='More on Health Care' tag='health-care']“There will be some sliver of people who will have to pay the full cost,” Eibner said. “A lot of people are protected so maybe they don’t care, but who is paying? Ultimately it’s the taxpayer.”\u003c/p>\n\u003cp>A significant number of people who are no longer eligible for Medi-Cal, the state’s public insurance program for individuals with very low-income, also are expected to enroll in Covered California, which could drive future cost increases.\u003c/p>\n\u003cp>“That population is relatively expensive,” Eibner said. “People who are lower income have more health care issues, and bringing them into the market may lead to higher premiums.”\u003c/p>\n\u003cp>The state paused \u003ca href=\"https://calmatters.org/health/2023/07/medi-cal-eligibility-california-review/\">checking people for Medi-Cal eligibility\u003c/a> during the federal COVID-19 public health emergency, but about 225,000 Californians have been kicked off since the state resumed monthly reviews this year. Covered California’s enrollment period runs from November through the end of January.\u003c/p>\n\u003cp>\u003c/p>\n","blocks":[],"excerpt":"California still offers generous subsidies, but the rate hike signals that runaway health care costs are back after 5 years of low premium increases.","status":"publish","parent":0,"modified":1690400113,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":17,"wordCount":803},"headData":{"title":"'It's Worrisome': Covered California Announces Biggest Increase in Premiums | KQED","description":"California still offers generous subsidies, but the rate hike signals that runaway health care costs are back after 5 years of low premium increases.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"source":"CalMatters","sourceUrl":"https://calmatters.org/","nprByline":"\u003ca href=\"https://calmatters.org/author/kristen-hwang/\">Kristen Hwang\u003c/a>","excludeFromSiteSearch":"Include","showOnAuthorArchivePages":"No","articleAge":"0","path":"/news/11956545/its-worrisome-covered-california-announces-biggest-increase-in-premiums","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Premiums for health insurance sold through the state marketplace will increase by nearly 10% next year, the highest rate hike since 2018, \u003ca href=\"https://www.coveredca.com/newsroom/news-releases/2023/07/25/\">Covered California officials announced\u003c/a> Tuesday.\u003c/p>\n\u003cp>The projected 9.6% hike is the result of a “complicated time for health care,” Covered California Executive Director Jessica Altman said during a media briefing, but many Californians will be shielded from the increases as a result of federal and state financial assistance.\u003c/p>\n\u003cp>About 90% of enrollees qualify for some type of federal or state financial aid and 20% will see no change in their monthly premium, officials said. About 1.6 million Californians turn to the marketplace for health insurance, which offers plans that cost as little as $10 a month.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The rate increase, however, represents the return of a troubling trend: \u003ca href=\"https://calmatters.org/health/2022/07/rising-health-care-costs/\">runaway health care costs\u003c/a>, experts said.\u003c/p>\n\u003cp>“We’re seeing even larger increases in the private market. It’s worrisome,” said Anthony Wright, executive director of Health Access California, a consumer advocate group. “Individual consumers need health coverage and they need help now.”\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘We’re seeing even larger increases in the private market. It’s worrisome. Individual consumers need health coverage and they need help now.’","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Anthony Wright, executive director, Health Access California","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>During the COVID-19 pandemic, an influx of $3 billion from the federal government helped dampen the effect of rising health care costs in California. Covered California premium increases held below 2% between 2020 and 2022.\u003c/p>\n\u003cp>The federal government extended assistance for two more years, but the 2024 increase reflects post-pandemic inflationary pressures, such as \u003ca href=\"https://calmatters.org/health/2023/05/cost-of-insulin/\">higher drug costs\u003c/a>, more people going to see the doctor, labor shortages and wage costs, Altman said.\u003c/p>\n\u003cp>The rate hikes vary by region, with more than one-third of enrollees potentially experiencing a double-digit increase, according to state data. Those who live in Mono, Inyo and Imperial counties may see the largest price increase at 15.8% compared to last year. Those same counties also experienced the \u003ca href=\"https://calmatters.org/health/2022/07/covered-california-rates/\">largest increase last year\u003c/a>.\u003c/p>\n\u003cp>“We’re glad that Covered California has federal and state subsidies to provide immediate help now, but we do need policymakers to double down on containing the costs of health care long-term,” Wright said. “This is a clarion call for the overall cost of health care going forward.”\u003c/p>\n\u003ch2>Covered California waives deductibles for many\u003c/h2>\n\u003cp>Last week, the \u003ca href=\"https://calmatters.org/newsletters/whatmatters/2023/07/california-cost-of-living-3/#wm-story-1\">Covered California board voted\u003c/a> to implement a plan that will make coverage more affordable for about 650,000 enrollees by eliminating their deductibles for the coming year.\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11949192","hero":"https://ww2.kqed.org/app/uploads/sites/10/2023/05/IMG_0196-1-1020x765.jpg","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>The vote capped a \u003ca href=\"https://calmatters.org/health/2023/05/covered-california-cost/\">drawn-out budget battle\u003c/a> between Gov. Gavin Newsom, legislators and health care consumer advocates who have \u003ca href=\"https://calmatters.org/health/2023/02/health-care-costs/\">criticized Newsom\u003c/a> for repeatedly moving money intended for health care subsidies into the state’s general fund.\u003c/p>\n\u003cp>Under the plan, deductibles will be eliminated for individuals earning as much as $33,975 annually and families earning up to $69,375 annually. Previously, people with those plans paid deductibles of up to $5,400. The new plan also significantly reduces out-of-pocket copays for doctor visits and prescription drugs.\u003c/p>\n\u003cp>“Despite the rate increase, Californians who enroll in health care coverage through Covered California will benefit from the greatest level of financial support ever offered … as we head into 2024,” Altman said.\u003c/p>\n\u003ch2>‘Hefty’ health insurance increase\u003c/h2>\n\u003cp>Christine Eibner, a senior economist with the RAND Corporation, a research and policy think tank, called the state’s projected premium increase “hefty.”\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"label":"More on Health Care ","tag":"health-care"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>“There will be some sliver of people who will have to pay the full cost,” Eibner said. “A lot of people are protected so maybe they don’t care, but who is paying? Ultimately it’s the taxpayer.”\u003c/p>\n\u003cp>A significant number of people who are no longer eligible for Medi-Cal, the state’s public insurance program for individuals with very low-income, also are expected to enroll in Covered California, which could drive future cost increases.\u003c/p>\n\u003cp>“That population is relatively expensive,” Eibner said. “People who are lower income have more health care issues, and bringing them into the market may lead to higher premiums.”\u003c/p>\n\u003cp>The state paused \u003ca href=\"https://calmatters.org/health/2023/07/medi-cal-eligibility-california-review/\">checking people for Medi-Cal eligibility\u003c/a> during the federal COVID-19 public health emergency, but about 225,000 Californians have been kicked off since the state resumed monthly reviews this year. Covered California’s enrollment period runs from November through the end of January.\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11956545/its-worrisome-covered-california-announces-biggest-increase-in-premiums","authors":["byline_news_11956545"],"categories":["news_457","news_8"],"tags":["news_21352","news_18538","news_5164","news_683","news_1054","news_32709"],"affiliates":["news_18481"],"featImg":"news_11956568","label":"source_news_11956545"},"news_11951994":{"type":"posts","id":"news_11951994","meta":{"index":"posts_1591205157","site":"news","id":"11951994","score":null,"sort":[1686181049000]},"guestAuthors":[],"slug":"for-many-long-covid-patients-qualifying-for-disability-is-half-the-battle","title":"For Many Long COVID Patients, Qualifying for Disability Is Half the Battle","publishDate":1686181049,"format":"standard","headTitle":"For Many Long COVID Patients, Qualifying for Disability Is Half the Battle | KQED","labelTerm":{"site":"news"},"content":"\u003cp>Chris Pham contracted COVID-19 at the onset of the pandemic, in March 2020, and just couldn’t kick it.\u003c/p>\n\u003cp>“I was two weeks in, and the first time that I realized something was really wrong was when I decided to take a run,” said the now-35-year-old, who had been living in the Bay Area in good health and was training for a triathlon. “I was feeling a little bit better. … But after mile 1, I can remember really thinking, ‘Wow, there’s something that’s totally wrong with my body.’ And I broke into a cold sweat and I just couldn’t run anymore.”\u003c/p>\n\u003cp>Pham said his doctors, who at that point still knew very little about the virus, struggled to explain and diagnose his condition, which is now clearly understood to be what’s known as long COVID. “My doctors didn’t have any data really to base a diagnosis off of,” he said. “So, yeah, I was given the runaround or not really believed. And that was a scary, scary thing in and of itself.”[aside postID=news_11950643 hero='https://ww2.kqed.org/app/uploads/sites/10/2023/05/RS65622_005_KQED_LongCOVIDCharlieMcCone_05182023-qut-1020x680.jpg']Pham said he generally learned how to manage his symptoms, but was often overwhelmed with paralyzing fatigue. He eventually tried to return to work full-time, as the head of sales of a Bay Area start-up, but found it nearly impossible to get through the day.\u003c/p>\n\u003cp>“I was passing out in the middle of the day after one or two meetings and it would cause and trigger my long COVID symptoms,” he said. “On calls, there was extreme fatigue and then this pain, like heavy sinking pain. Just like someone attached a 50-pound anchor to your face and let it drop to the bottom of the ocean.”\u003c/p>\n\u003cp>Pham had to take medical leave, and was ultimately laid off. But after his initial disability payments petered out, he struggled to secure the long-term disability benefits he needed to pay for basic living expenses and medical care.\u003c/p>\n\u003cp>Fast-forward more than three years: Pham still suffers from debilitating symptoms stemming from his initial infection — among the estimated millions of long COVID patients in the U.S. — and says applying for and receiving the payments has been a constant struggle.\u003c/p>\n\u003cp>“The process was extremely difficult to receive the funds, even though it was approved. The disability company would often come back and say, ‘It needs a review.’ And this happened every single month,” Pham said of his initial efforts to apply for long-term disability, noting that his insurance company often required him to do additional testing to prove his eligibility. “So I had no certainty on how to plan. I was basically chasing down my benefits the whole time.”\u003c/p>\n\u003cfigure id=\"attachment_11952470\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2023/06/060723-Chris-Pham-KQED.jpg\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11952470 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/06/060723-Chris-Pham-KQED.jpg\" alt=\"A young Asian man in a gray T-shirt rests on a brown leather couch with his eyes closed.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/06/060723-Chris-Pham-KQED.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2023/06/060723-Chris-Pham-KQED-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/06/060723-Chris-Pham-KQED-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/06/060723-Chris-Pham-KQED-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/06/060723-Chris-Pham-KQED-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Chris Pham rests on the couch at his parents’ house in Arizona, where he now lives. \u003ccite>(Courtesy Chris Pham)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Pham’s insurance company eventually terminated his long-term benefits, and with no source of income, he was forced to move back in with his parents in Arizona.\u003c/p>\n\u003cp>“If I didn’t have the support of my family, I’d be out on the streets,” he said. “[Insurers] are willing to let all the folks with long COVID who are currently suffering go without the benefits that are rightly owed to them.”\u003c/p>\n\u003cp>His insurance company, Guardian, did not return KQED’s request for comment about his case.\u003c/p>\n\u003cp>A big part of the problem for patients: There’s no single definition of long COVID and no singular test to determine whether someone has it, making it easier for insurance companies to deny claims.[pullquote align=\"right\" size=\"medium\" citation=\"Chris Pham, long COVID patient\"]‘If I didn’t have the support of my family, I’d be out on the streets.’[/pullquote]“I would urge the CDC and the World Health Organization [to] encourage a clinical diagnosis of long COVID,” said David Putrino, a physical therapist at Mount Sinai Health System in New York, who has worked with thousands of long COVID patients over the last three years.\u003c/p>\n\u003cp>“[T]he payers and the people denying benefits to people with long COVID always say the same thing: ‘Oh, you don’t have enough evidence. We don’t have an objective test to prove that you’re sick,’” he said. “Please let us stop asking sick people to prove to us that they’re sick.”\u003c/p>\n\u003cp>Pham spent months fighting with Guardian to reinstate his long-term disability payments, and finally won his appeal in January.\u003c/p>\n\u003cp>Cassie Springer Ayeni, Pham’s attorney who helped wage his protracted legal challenge, says securing such benefits can be a lifesaver for people with long COVID.\u003c/p>\n\u003cfigure id=\"attachment_11952494\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2023/06/RS66047_005_KQED_CassieSpringerAyeniLongCovid_06052023-qut-1.jpg\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11952494 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/06/RS66047_005_KQED_CassieSpringerAyeniLongCovid_06052023-qut-1.jpg\" alt=\"A middle-aged white woman with glasses, wearing a business jacket, holds a large stack of papers. \" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/06/RS66047_005_KQED_CassieSpringerAyeniLongCovid_06052023-qut-1.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2023/06/RS66047_005_KQED_CassieSpringerAyeniLongCovid_06052023-qut-1-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/06/RS66047_005_KQED_CassieSpringerAyeniLongCovid_06052023-qut-1-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/06/RS66047_005_KQED_CassieSpringerAyeniLongCovid_06052023-qut-1-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/06/RS66047_005_KQED_CassieSpringerAyeniLongCovid_06052023-qut-1-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Cassie Springer Ayeni, a disability attorney in San Leandro who works with many long COVID patients, shows a thick stack of her client’s disability claims, on June 5, 2023.\u003c/figcaption>\u003c/figure>\n\u003cp>“These benefits typically do last through age 67 for people who are affected by long COVID or any other disabling condition,” she said, noting that half of her new clients suffer from long COVID. “That’s why they’re so valuable — because this is potentially income for somebody who might not be able to ever return to the workforce.”\u003c/p>\n\u003cp>Springer Ayeni says such uncertainty leaves many people with long COVID in both a physical and financial bind.\u003c/p>\n\u003cp>“People take loans and people take loans from family. And because of the cost of living in the Bay Area, a lot of my clients wind up selling their house, moving somewhere else,” she said. “I’ve had two clients just in the last year have to give up living in the Bay Area because of their disabilities, because they can’t live off of an unreliable source of income.”\u003c/p>\n\u003cp>The true economic cost of long COVID in the United States likely won’t be fully realized for years, if ever, particularly because the U.S. has done a poor overall job of tracking the condition, said Katie Bach, senior fellow at the Brookings Institution.[pullquote align=\"right\" size=\"medium\" citation=\"Katie Bach, senior fellow, Brookings Institution\"]‘My best estimate is that we have millions of full-time-equivalent workers not working and out of the labor force due to long COVID.’[/pullquote]“My best estimate is that we have millions of full-time-equivalent workers not working and out of the labor force due to long COVID. So that’s somewhere between $100 billion and $230 billion a year in lost wages,” she said. “This is not the first post-viral illness that we have seen in the U.S. We’ve just never seen an outbreak of this scale.”\u003c/p>\n\u003cp>But from an insurer’s perspective, long COVID poses a number of major issues, says Linda Bergthold, a health policy consultant and researcher. She says one of the biggest issues is that there have been no diagnostic codes for long COVID. Those codes, which doctors have to denote when requesting coverage for their patients, are a key part of the claims process. And because there are so many symptoms associated with the condition — from fatigue to heart issues — some of the codes don’t necessarily cover the health problems that a long COVID patient might be experiencing.\u003c/p>\n\u003cp>Additionally, she said, insurance companies have a notorious history — one far predating COVID — of denying treatment claims they do not deem a “medical necessity.” That vague benchmark has proved particularly detrimental to long COVID patients seeking new treatments that have not yet been scientifically proven — and that insurance companies often consider unnecessary.\u003c/p>\n\u003cp>Although Chris Pham won his appeal for disability benefits, he says he still struggles on a day-to-day basis.\u003c/p>\n\u003cp>“I don’t have the ability to provide for myself,” he said. “I don’t [even] have the ability to do the dishes.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"Many of the millions of Americans believed to have long COVID are unable to work, but often struggle to secure the medical treatment and long-term disability benefits they need to survive.\r\n","status":"publish","parent":0,"modified":1686181049,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":1404},"headData":{"title":"For Many Long COVID Patients, Qualifying for Disability Is Half the Battle | KQED","description":"Many of the millions of Americans believed to have long COVID are unable to work, but often struggle to secure the medical treatment and long-term disability benefits they need to survive.\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"excludeFromSiteSearch":"Include","articleAge":"0","path":"/news/11951994/for-many-long-covid-patients-qualifying-for-disability-is-half-the-battle","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Chris Pham contracted COVID-19 at the onset of the pandemic, in March 2020, and just couldn’t kick it.\u003c/p>\n\u003cp>“I was two weeks in, and the first time that I realized something was really wrong was when I decided to take a run,” said the now-35-year-old, who had been living in the Bay Area in good health and was training for a triathlon. “I was feeling a little bit better. … But after mile 1, I can remember really thinking, ‘Wow, there’s something that’s totally wrong with my body.’ And I broke into a cold sweat and I just couldn’t run anymore.”\u003c/p>\n\u003cp>Pham said his doctors, who at that point still knew very little about the virus, struggled to explain and diagnose his condition, which is now clearly understood to be what’s known as long COVID. “My doctors didn’t have any data really to base a diagnosis off of,” he said. “So, yeah, I was given the runaround or not really believed. And that was a scary, scary thing in and of itself.”\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11950643","hero":"https://ww2.kqed.org/app/uploads/sites/10/2023/05/RS65622_005_KQED_LongCOVIDCharlieMcCone_05182023-qut-1020x680.jpg","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Pham said he generally learned how to manage his symptoms, but was often overwhelmed with paralyzing fatigue. He eventually tried to return to work full-time, as the head of sales of a Bay Area start-up, but found it nearly impossible to get through the day.\u003c/p>\n\u003cp>“I was passing out in the middle of the day after one or two meetings and it would cause and trigger my long COVID symptoms,” he said. “On calls, there was extreme fatigue and then this pain, like heavy sinking pain. Just like someone attached a 50-pound anchor to your face and let it drop to the bottom of the ocean.”\u003c/p>\n\u003cp>Pham had to take medical leave, and was ultimately laid off. But after his initial disability payments petered out, he struggled to secure the long-term disability benefits he needed to pay for basic living expenses and medical care.\u003c/p>\n\u003cp>Fast-forward more than three years: Pham still suffers from debilitating symptoms stemming from his initial infection — among the estimated millions of long COVID patients in the U.S. — and says applying for and receiving the payments has been a constant struggle.\u003c/p>\n\u003cp>“The process was extremely difficult to receive the funds, even though it was approved. The disability company would often come back and say, ‘It needs a review.’ And this happened every single month,” Pham said of his initial efforts to apply for long-term disability, noting that his insurance company often required him to do additional testing to prove his eligibility. “So I had no certainty on how to plan. I was basically chasing down my benefits the whole time.”\u003c/p>\n\u003cfigure id=\"attachment_11952470\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2023/06/060723-Chris-Pham-KQED.jpg\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11952470 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/06/060723-Chris-Pham-KQED.jpg\" alt=\"A young Asian man in a gray T-shirt rests on a brown leather couch with his eyes closed.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/06/060723-Chris-Pham-KQED.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2023/06/060723-Chris-Pham-KQED-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/06/060723-Chris-Pham-KQED-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/06/060723-Chris-Pham-KQED-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/06/060723-Chris-Pham-KQED-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Chris Pham rests on the couch at his parents’ house in Arizona, where he now lives. \u003ccite>(Courtesy Chris Pham)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Pham’s insurance company eventually terminated his long-term benefits, and with no source of income, he was forced to move back in with his parents in Arizona.\u003c/p>\n\u003cp>“If I didn’t have the support of my family, I’d be out on the streets,” he said. “[Insurers] are willing to let all the folks with long COVID who are currently suffering go without the benefits that are rightly owed to them.”\u003c/p>\n\u003cp>His insurance company, Guardian, did not return KQED’s request for comment about his case.\u003c/p>\n\u003cp>A big part of the problem for patients: There’s no single definition of long COVID and no singular test to determine whether someone has it, making it easier for insurance companies to deny claims.\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘If I didn’t have the support of my family, I’d be out on the streets.’","name":"pullquote","attributes":{"named":{"align":"right","size":"medium","citation":"Chris Pham, long COVID patient","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>“I would urge the CDC and the World Health Organization [to] encourage a clinical diagnosis of long COVID,” said David Putrino, a physical therapist at Mount Sinai Health System in New York, who has worked with thousands of long COVID patients over the last three years.\u003c/p>\n\u003cp>“[T]he payers and the people denying benefits to people with long COVID always say the same thing: ‘Oh, you don’t have enough evidence. We don’t have an objective test to prove that you’re sick,’” he said. “Please let us stop asking sick people to prove to us that they’re sick.”\u003c/p>\n\u003cp>Pham spent months fighting with Guardian to reinstate his long-term disability payments, and finally won his appeal in January.\u003c/p>\n\u003cp>Cassie Springer Ayeni, Pham’s attorney who helped wage his protracted legal challenge, says securing such benefits can be a lifesaver for people with long COVID.\u003c/p>\n\u003cfigure id=\"attachment_11952494\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2023/06/RS66047_005_KQED_CassieSpringerAyeniLongCovid_06052023-qut-1.jpg\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"wp-image-11952494 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2023/06/RS66047_005_KQED_CassieSpringerAyeniLongCovid_06052023-qut-1.jpg\" alt=\"A middle-aged white woman with glasses, wearing a business jacket, holds a large stack of papers. \" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2023/06/RS66047_005_KQED_CassieSpringerAyeniLongCovid_06052023-qut-1.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/10/2023/06/RS66047_005_KQED_CassieSpringerAyeniLongCovid_06052023-qut-1-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2023/06/RS66047_005_KQED_CassieSpringerAyeniLongCovid_06052023-qut-1-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2023/06/RS66047_005_KQED_CassieSpringerAyeniLongCovid_06052023-qut-1-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2023/06/RS66047_005_KQED_CassieSpringerAyeniLongCovid_06052023-qut-1-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Cassie Springer Ayeni, a disability attorney in San Leandro who works with many long COVID patients, shows a thick stack of her client’s disability claims, on June 5, 2023.\u003c/figcaption>\u003c/figure>\n\u003cp>“These benefits typically do last through age 67 for people who are affected by long COVID or any other disabling condition,” she said, noting that half of her new clients suffer from long COVID. “That’s why they’re so valuable — because this is potentially income for somebody who might not be able to ever return to the workforce.”\u003c/p>\n\u003cp>Springer Ayeni says such uncertainty leaves many people with long COVID in both a physical and financial bind.\u003c/p>\n\u003cp>“People take loans and people take loans from family. And because of the cost of living in the Bay Area, a lot of my clients wind up selling their house, moving somewhere else,” she said. “I’ve had two clients just in the last year have to give up living in the Bay Area because of their disabilities, because they can’t live off of an unreliable source of income.”\u003c/p>\n\u003cp>The true economic cost of long COVID in the United States likely won’t be fully realized for years, if ever, particularly because the U.S. has done a poor overall job of tracking the condition, said Katie Bach, senior fellow at the Brookings Institution.\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘My best estimate is that we have millions of full-time-equivalent workers not working and out of the labor force due to long COVID.’","name":"pullquote","attributes":{"named":{"align":"right","size":"medium","citation":"Katie Bach, senior fellow, Brookings Institution","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>“My best estimate is that we have millions of full-time-equivalent workers not working and out of the labor force due to long COVID. So that’s somewhere between $100 billion and $230 billion a year in lost wages,” she said. “This is not the first post-viral illness that we have seen in the U.S. We’ve just never seen an outbreak of this scale.”\u003c/p>\n\u003cp>But from an insurer’s perspective, long COVID poses a number of major issues, says Linda Bergthold, a health policy consultant and researcher. She says one of the biggest issues is that there have been no diagnostic codes for long COVID. Those codes, which doctors have to denote when requesting coverage for their patients, are a key part of the claims process. And because there are so many symptoms associated with the condition — from fatigue to heart issues — some of the codes don’t necessarily cover the health problems that a long COVID patient might be experiencing.\u003c/p>\n\u003cp>Additionally, she said, insurance companies have a notorious history — one far predating COVID — of denying treatment claims they do not deem a “medical necessity.” That vague benchmark has proved particularly detrimental to long COVID patients seeking new treatments that have not yet been scientifically proven — and that insurance companies often consider unnecessary.\u003c/p>\n\u003cp>Although Chris Pham won his appeal for disability benefits, he says he still struggles on a day-to-day basis.\u003c/p>\n\u003cp>“I don’t have the ability to provide for myself,” he said. “I don’t [even] have the ability to do the dishes.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11951994/for-many-long-covid-patients-qualifying-for-disability-is-half-the-battle","authors":["11739"],"categories":["news_457","news_8","news_356"],"tags":["news_27350","news_27504","news_27626","news_1054","news_30415","news_32785","news_27660"],"featImg":"news_11952465","label":"news"},"news_11948505":{"type":"posts","id":"news_11948505","meta":{"index":"posts_1591205157","site":"news","id":"11948505","score":null,"sort":[1683291642000]},"guestAuthors":[],"slug":"newsom-breaks-deal-to-lower-price-of-covered-california-lawmakers-move-to-hold-him-to-it","title":"Lawmakers, Newsom Squabble Over Promise to Lower Costs of Covered California","publishDate":1683291642,"format":"standard","headTitle":"Lawmakers, Newsom Squabble Over Promise to Lower Costs of Covered California | KQED","labelTerm":{"term":18481,"site":"news"},"content":"\u003cp>The adage “get it in writing” applies to politics as much as anything else, and it would seem the California Legislature could learn a lesson or two.\u003c/p>\n\u003cp>Legislators and advocates have been pushing Gov. Gavin Newsom since last year to make good on a \u003ca href=\"https://calmatters.org/health/2023/02/health-care-costs/\">longtime promise\u003c/a> to funnel money from a controversial tax penalty into the Covered California marketplace, making health insurance cheaper for nearly 1 million enrollees. The problem — or at least the argument Newsom has always made — is that state statute doesn’t require the penalty money to be used on health care. It goes directly into the general fund — where it has stayed for most of the past four years.[pullquote size=\"medium\" align=\"right\" citation=\"Assemblymember Joaquin Arambula\"]‘I’m trying to make sure that those dollars stay in this area to address affordability, and I’m not hearing from the administration that same commitment.’[/pullquote]\u003c/p>\n\u003cp>But legislators say that’s not what they intended when they voted on the measure in 2019. Senate leadership signaled its intent last week to ensure in writing that the money will “further lower the costs of health coverage for lower- and middle-income Californians” moving forward. The \u003ca href=\"https://sbud.senate.ca.gov/sites/sbud.senate.ca.gov/files/Protect%20Our%20Progress%20Senate%20Budget%20Plan.pdf\">Senate budget proposal rejects Newsom’s plan (PDF)\u003c/a> to temporarily move $333.4 million in penalty money from an affordability reserve to the general fund, calling it a “rip-off” of Covered California funds.\u003c/p>\n\u003cp>“Our plan protects important advancements that California has made that has moved us towards a more equitable and sustainable economy,” Senate Budget Chair \u003ca href=\"https://calmatters.org/legislator-tracker/nancy-skinner-1954/\">Nancy Skinner\u003c/a> said during a press briefing last week.\u003c/p>\n\u003cp>In 2019, Newsom proposed and the Legislature passed a polarizing tax penalty on Californians without health insurance, known as the individual mandate, with verbal assurances that it would be used to lower health care costs for those who have insurance through Covered California, the state version of the Affordable Care Act marketplace. Though \u003ca href=\"https://californiahealthline.org/news/article/health-insurance-mandate-penalties/\">more than $1 billion has been collected in the past four years\u003c/a>, the money has only been used once to lower costs for enrollees, about $355 million in 2020.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The \u003ca href=\"https://sbud.senate.ca.gov/sites/sbud.senate.ca.gov/files/Protect%20Our%20Progress%20Senate%20Budget%20Plan.pdf\">Senate Democrats’ budget proposal (PDF)\u003c/a>, which relies on corporate tax hikes that \u003ca href=\"https://calmatters.org/newsletters/whatmatters/2023/04/california-taxes-budget/\">Newsom swiftly rejected\u003c/a> to avoid a variety of cuts, \u003ca href=\"https://calmatters.org/commentary/2023/05/democrats-at-odds-budget-deficit/\">sets the stage for an intense period of negotiation\u003c/a> between the Legislature and governor as they hash out a state spending plan in the face of diminishing tax revenue. The Senate’s counter proposal would mandate using the money to eliminate deductibles and copays for roughly 900,000 Covered California enrollees next year. It’s one of several health care funding battles heating up amid a bleak budget year, including a fight to infuse emergency cash into \u003ca href=\"https://calmatters.org/health/2023/04/hospital-closures-california/\">hospitals on the brink of closure\u003c/a>.\u003c/p>\n\u003cp>Newsom is expected to disclose later this month an even more dismal financial picture for the state than the \u003ca href=\"https://calmatters.org/california-budget/2023/01/california-budget-newsom-deficit/\">$22.5 billion deficit he projected in his January budget proposal\u003c/a>.\u003c/p>\n\u003cp>In a statement, Brandon Richards, spokesperson for Newsom, said the governor will “continue to work with the California Legislature to develop the final budget package” in the coming months.\u003c/p>\n\u003cp>This is just one step in a long budget negotiation that will stretch to June. If the Senate’s counterproposal makes it into the state’s final budget come summer, leadership intends to end the diversion of penalty money permanently. Notably, Democratic leaders from the Assembly have not endorsed the Senate’s spending plan nor put forth their own proposal, but John Casey, communications director for Assembly Speaker Anthony Rendon, said both houses are interested in the issue.\u003c/p>\n\u003cp>“We’ll see what the May revision includes and the two houses will advance their priorities as best they can in negotiations afterward,” Casey said.\u003c/p>\n\u003ch2>‘A bitter pill’\u003c/h2>\n\u003cp>In recent committee hearings, Assembly and Senate legislators have lambasted this particular proposal in Newsom’s budget.\u003c/p>\n\u003cp>“I’m trying to make sure that those dollars stay in this area to address affordability, and I’m not hearing from the administration that same commitment,” said Assemblymember \u003ca href=\"https://calmatters.org/legislator-tracker/joaquin-arambula-1977/\">Joaquin Arambula\u003c/a>, a Fresno Democrat and chairperson of the Assembly budget subcommittee on health.[aside postID=\"news_11944543,news_11944091\" label=\"Related Posts\"]Sen. \u003ca href=\"https://calmatters.org/legislator-tracker/caroline-menjivar-1989/\">Caroline Menjivar\u003c/a>, a newly elected Democrat from Van Nuys and chairperson of the Senate budget subcommittee on health, criticized the governor’s plan for saving money “on the backs of our low-income communities.”\u003c/p>\n\u003cp>On his first day in office, Newsom proposed reinstating a tax on people without health insurance to fund increased subsidies for people who have Covered California insurance. A previous \u003ca href=\"https://www.cnbc.com/2018/01/30/trump-touts-repeal-of-obamacare-individual-mandate.html\">federal version of the tax had been repealed by the Trump administration\u003c/a> the year prior, which contributed to a \u003ca href=\"https://hbex.coveredca.com/financial-reports/PDFs/2019/fy-2019-20-annual-report-final.pdf\">24% drop in enrollment in Covered California plans (PDF)\u003c/a>.\u003c/p>\n\u003cp>New taxes always trigger a \u003ca href=\"https://www.capradio.org/articles/2019/02/21/californias-individual-mandate-a-fix-for-a-broken-system-or-a-penalty-on-the-poor/\">legislative skirmish\u003c/a>, but this one gave even Democratic lawmakers and powerful advocacy groups pause: Theoretically, the tax would encourage more people to get health insurance, lowering the overall cost for everyone in the marketplace, but the penalty would come out of the pockets of the state’s poorest residents — those who forego insurance because it’s too expensive.\u003c/p>\n\u003cp>The Legislature ultimately approved the tax in 2019 with the understanding that the projected $1.4 billion in revenue over three years would be used to lower insurance costs.\u003c/p>\n\u003cp>The majority of that money, however, has stayed in the state’s general fund. Newsom has previously argued that the federal government’s more generous COVID-19 subsidies, which extend through 2025, render additional state spending unnecessary, especially at a time when California faces a growing deficit.\u003c/p>\n\u003cp>But legislators in both the Senate and the Assembly say that’s not what they voted for.\u003c/p>\n\u003cp>“The individual mandate was not intended to create funds for other government programs outside of health care from my perspective,” Assemblymember \u003ca href=\"https://calmatters.org/legislator-tracker/jim-wood-1960/\">Jim Wood\u003c/a> said during a recent budget subcommittee meeting. “I don’t think I would have supported it if that was the way I thought it would end up.”\u003c/p>\n\u003cp>Wood, a Democrat from Santa Rosa who leads the Assembly Health Committee, called the diversion to the general fund “a bitter pill to swallow.”\u003c/p>\n\u003cp>During the hearing, Department of Finance analyst Matt Aguilera argued using the money to alleviate the deficit would not impact current services under Covered California.\u003c/p>\n\u003cp>“Everybody is concerned about affordability. There’s agreement on that. Just due to the economic situation this may not be a good time to start up new programs,” Aguilera said.\u003c/p>\n\u003cp>But advocates argue using the revenue from the individual mandate penalty wouldn’t be new spending. It would be fulfilling an existing commitment.\u003c/p>\n\u003ch2>Costs keep rising\u003c/h2>\n\u003cp>Last year, in tandem with \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB944\">a measure to ensure the penalty money no longer got diverted\u003c/a>, the Covered California board approved a plan to eliminate deductibles for the state’s \u003ca href=\"https://www.healthforcalifornia.com/covered-california/plans?gclid=CjwKCAjwxr2iBhBJEiwAdXECw-W0XW5KoSAgoaM1h7Q2V7Khe0nQuGMOs73i3BBK8Mnu7fhFl6vjzRoC-wIQAvD_BwE\">mid-tier coverage option\u003c/a>, which is widely considered the most cost-effective insurance option. When \u003ca href=\"https://www.gov.ca.gov/wp-content/uploads/2022/09/SB-944-veto-message.pdf?emrc=af81f2\">Newsom vetoed the policy bill (PDF)\u003c/a>, citing a “downturn in revenues,” the plan was abandoned.\u003c/p>\n\u003cp>“Last year this was a priority for everybody: the health plans, business groups, both the Assembly and Senate prioritized it in their budgets, health advocates, Covered California itself. Everybody lined up to support this,” said Rachel Linn Gish, communications director for Health Access California, a consumer advocacy lobbying group. “The only person we didn’t have was the governor.”\u003c/p>\n\u003cp>Instead, \u003ca href=\"https://www.coveredca.com/pdfs/2022-Health-Benefits-table.pdf\">deductibles jumped from $3,700 for an individual and $7,400 for a family with a mid-tier plan (PDF)\u003c/a> to \u003ca href=\"https://www.coveredca.com/pdfs/Health-Benefits-table.pdf\">$4,750 and $9,500, respectively (PDF)\u003c/a>. Health Access is sponsoring \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB1208\">another measure\u003c/a> this year to ensure money appropriated for Covered California affordability measures is used for that purpose.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://flo.uri.sh/visualisation/12755159/embed?auto=1\" width=\"800\" height=\"550\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>“One of the most direct and impactful ways we can make sure consumers get health care access right now is by lowering the cost of care,” Linn Gish said. “The 2025 (federal subsidy) sunset was the governor’s main sticking point … but to us, it’s 2023. Why can’t we help people now?”\u003c/p>\n\u003cp>Senate Democrats also rejected delays and cuts to investments in the state’s health care workforce, including a $49.8 million cut to training programs for public health workers. Michelle Gibbons, executive director of the County Health Executives Association of California, said the money was sorely needed after decades of public health budget cuts left the state scrambling to respond to the COVID-19 pandemic.\u003c/p>\n\u003cp>“We can’t even begin to grow the pipeline of microbiologists, lab directors, epidemiologists — very skilled positions — without these programs and investments,” Gibbons said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>It’s unclear, however, how feasible the Senate Democrats’ proposal is with the state facing an economic downturn. Most of the cuts avoided are funded through a $6 billion proposed corporate tax hike and $5 billion suspension of a major tax credit, which \u003ca href=\"https://calmatters.org/newsletters/whatmatters/2023/04/california-taxes-budget/\">Newsom rejected within hours of the proposal’s release\u003c/a>.\u003c/p>\n\n","blocks":[],"excerpt":"In 2019, Gov. Gavin Newsom proposed and the Legislature approved a tax penalty on Californians without health insurance. That money was supposed to be used to lower costs for those insured through Covered California, but that has only happened once.","status":"publish","parent":0,"modified":1683244203,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":true,"iframeSrcs":["https://flo.uri.sh/visualisation/12755159/embed"],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":32,"wordCount":1536},"headData":{"title":"Lawmakers, Newsom Squabble Over Promise to Lower Costs of Covered California | KQED","description":"In 2019, Gov. Gavin Newsom proposed and the Legislature approved a tax penalty on Californians without health insurance. That money was supposed to be used to lower costs for those insured through Covered California, but that has only happened once.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"nprByline":"\u003ca href=\"https://calmatters.org/author/kristen-hwang/\">Kristen Hwang\u003c/a>","excludeFromSiteSearch":"Include","showOnAuthorArchivePages":"No","articleAge":"0","path":"/news/11948505/newsom-breaks-deal-to-lower-price-of-covered-california-lawmakers-move-to-hold-him-to-it","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The adage “get it in writing” applies to politics as much as anything else, and it would seem the California Legislature could learn a lesson or two.\u003c/p>\n\u003cp>Legislators and advocates have been pushing Gov. Gavin Newsom since last year to make good on a \u003ca href=\"https://calmatters.org/health/2023/02/health-care-costs/\">longtime promise\u003c/a> to funnel money from a controversial tax penalty into the Covered California marketplace, making health insurance cheaper for nearly 1 million enrollees. The problem — or at least the argument Newsom has always made — is that state statute doesn’t require the penalty money to be used on health care. It goes directly into the general fund — where it has stayed for most of the past four years.\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"‘I’m trying to make sure that those dollars stay in this area to address affordability, and I’m not hearing from the administration that same commitment.’","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Assemblymember Joaquin Arambula","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But legislators say that’s not what they intended when they voted on the measure in 2019. Senate leadership signaled its intent last week to ensure in writing that the money will “further lower the costs of health coverage for lower- and middle-income Californians” moving forward. The \u003ca href=\"https://sbud.senate.ca.gov/sites/sbud.senate.ca.gov/files/Protect%20Our%20Progress%20Senate%20Budget%20Plan.pdf\">Senate budget proposal rejects Newsom’s plan (PDF)\u003c/a> to temporarily move $333.4 million in penalty money from an affordability reserve to the general fund, calling it a “rip-off” of Covered California funds.\u003c/p>\n\u003cp>“Our plan protects important advancements that California has made that has moved us towards a more equitable and sustainable economy,” Senate Budget Chair \u003ca href=\"https://calmatters.org/legislator-tracker/nancy-skinner-1954/\">Nancy Skinner\u003c/a> said during a press briefing last week.\u003c/p>\n\u003cp>In 2019, Newsom proposed and the Legislature passed a polarizing tax penalty on Californians without health insurance, known as the individual mandate, with verbal assurances that it would be used to lower health care costs for those who have insurance through Covered California, the state version of the Affordable Care Act marketplace. Though \u003ca href=\"https://californiahealthline.org/news/article/health-insurance-mandate-penalties/\">more than $1 billion has been collected in the past four years\u003c/a>, the money has only been used once to lower costs for enrollees, about $355 million in 2020.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The \u003ca href=\"https://sbud.senate.ca.gov/sites/sbud.senate.ca.gov/files/Protect%20Our%20Progress%20Senate%20Budget%20Plan.pdf\">Senate Democrats’ budget proposal (PDF)\u003c/a>, which relies on corporate tax hikes that \u003ca href=\"https://calmatters.org/newsletters/whatmatters/2023/04/california-taxes-budget/\">Newsom swiftly rejected\u003c/a> to avoid a variety of cuts, \u003ca href=\"https://calmatters.org/commentary/2023/05/democrats-at-odds-budget-deficit/\">sets the stage for an intense period of negotiation\u003c/a> between the Legislature and governor as they hash out a state spending plan in the face of diminishing tax revenue. The Senate’s counter proposal would mandate using the money to eliminate deductibles and copays for roughly 900,000 Covered California enrollees next year. It’s one of several health care funding battles heating up amid a bleak budget year, including a fight to infuse emergency cash into \u003ca href=\"https://calmatters.org/health/2023/04/hospital-closures-california/\">hospitals on the brink of closure\u003c/a>.\u003c/p>\n\u003cp>Newsom is expected to disclose later this month an even more dismal financial picture for the state than the \u003ca href=\"https://calmatters.org/california-budget/2023/01/california-budget-newsom-deficit/\">$22.5 billion deficit he projected in his January budget proposal\u003c/a>.\u003c/p>\n\u003cp>In a statement, Brandon Richards, spokesperson for Newsom, said the governor will “continue to work with the California Legislature to develop the final budget package” in the coming months.\u003c/p>\n\u003cp>This is just one step in a long budget negotiation that will stretch to June. If the Senate’s counterproposal makes it into the state’s final budget come summer, leadership intends to end the diversion of penalty money permanently. Notably, Democratic leaders from the Assembly have not endorsed the Senate’s spending plan nor put forth their own proposal, but John Casey, communications director for Assembly Speaker Anthony Rendon, said both houses are interested in the issue.\u003c/p>\n\u003cp>“We’ll see what the May revision includes and the two houses will advance their priorities as best they can in negotiations afterward,” Casey said.\u003c/p>\n\u003ch2>‘A bitter pill’\u003c/h2>\n\u003cp>In recent committee hearings, Assembly and Senate legislators have lambasted this particular proposal in Newsom’s budget.\u003c/p>\n\u003cp>“I’m trying to make sure that those dollars stay in this area to address affordability, and I’m not hearing from the administration that same commitment,” said Assemblymember \u003ca href=\"https://calmatters.org/legislator-tracker/joaquin-arambula-1977/\">Joaquin Arambula\u003c/a>, a Fresno Democrat and chairperson of the Assembly budget subcommittee on health.\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11944543,news_11944091","label":"Related Posts "},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Sen. \u003ca href=\"https://calmatters.org/legislator-tracker/caroline-menjivar-1989/\">Caroline Menjivar\u003c/a>, a newly elected Democrat from Van Nuys and chairperson of the Senate budget subcommittee on health, criticized the governor’s plan for saving money “on the backs of our low-income communities.”\u003c/p>\n\u003cp>On his first day in office, Newsom proposed reinstating a tax on people without health insurance to fund increased subsidies for people who have Covered California insurance. A previous \u003ca href=\"https://www.cnbc.com/2018/01/30/trump-touts-repeal-of-obamacare-individual-mandate.html\">federal version of the tax had been repealed by the Trump administration\u003c/a> the year prior, which contributed to a \u003ca href=\"https://hbex.coveredca.com/financial-reports/PDFs/2019/fy-2019-20-annual-report-final.pdf\">24% drop in enrollment in Covered California plans (PDF)\u003c/a>.\u003c/p>\n\u003cp>New taxes always trigger a \u003ca href=\"https://www.capradio.org/articles/2019/02/21/californias-individual-mandate-a-fix-for-a-broken-system-or-a-penalty-on-the-poor/\">legislative skirmish\u003c/a>, but this one gave even Democratic lawmakers and powerful advocacy groups pause: Theoretically, the tax would encourage more people to get health insurance, lowering the overall cost for everyone in the marketplace, but the penalty would come out of the pockets of the state’s poorest residents — those who forego insurance because it’s too expensive.\u003c/p>\n\u003cp>The Legislature ultimately approved the tax in 2019 with the understanding that the projected $1.4 billion in revenue over three years would be used to lower insurance costs.\u003c/p>\n\u003cp>The majority of that money, however, has stayed in the state’s general fund. Newsom has previously argued that the federal government’s more generous COVID-19 subsidies, which extend through 2025, render additional state spending unnecessary, especially at a time when California faces a growing deficit.\u003c/p>\n\u003cp>But legislators in both the Senate and the Assembly say that’s not what they voted for.\u003c/p>\n\u003cp>“The individual mandate was not intended to create funds for other government programs outside of health care from my perspective,” Assemblymember \u003ca href=\"https://calmatters.org/legislator-tracker/jim-wood-1960/\">Jim Wood\u003c/a> said during a recent budget subcommittee meeting. “I don’t think I would have supported it if that was the way I thought it would end up.”\u003c/p>\n\u003cp>Wood, a Democrat from Santa Rosa who leads the Assembly Health Committee, called the diversion to the general fund “a bitter pill to swallow.”\u003c/p>\n\u003cp>During the hearing, Department of Finance analyst Matt Aguilera argued using the money to alleviate the deficit would not impact current services under Covered California.\u003c/p>\n\u003cp>“Everybody is concerned about affordability. There’s agreement on that. Just due to the economic situation this may not be a good time to start up new programs,” Aguilera said.\u003c/p>\n\u003cp>But advocates argue using the revenue from the individual mandate penalty wouldn’t be new spending. It would be fulfilling an existing commitment.\u003c/p>\n\u003ch2>Costs keep rising\u003c/h2>\n\u003cp>Last year, in tandem with \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB944\">a measure to ensure the penalty money no longer got diverted\u003c/a>, the Covered California board approved a plan to eliminate deductibles for the state’s \u003ca href=\"https://www.healthforcalifornia.com/covered-california/plans?gclid=CjwKCAjwxr2iBhBJEiwAdXECw-W0XW5KoSAgoaM1h7Q2V7Khe0nQuGMOs73i3BBK8Mnu7fhFl6vjzRoC-wIQAvD_BwE\">mid-tier coverage option\u003c/a>, which is widely considered the most cost-effective insurance option. When \u003ca href=\"https://www.gov.ca.gov/wp-content/uploads/2022/09/SB-944-veto-message.pdf?emrc=af81f2\">Newsom vetoed the policy bill (PDF)\u003c/a>, citing a “downturn in revenues,” the plan was abandoned.\u003c/p>\n\u003cp>“Last year this was a priority for everybody: the health plans, business groups, both the Assembly and Senate prioritized it in their budgets, health advocates, Covered California itself. Everybody lined up to support this,” said Rachel Linn Gish, communications director for Health Access California, a consumer advocacy lobbying group. “The only person we didn’t have was the governor.”\u003c/p>\n\u003cp>Instead, \u003ca href=\"https://www.coveredca.com/pdfs/2022-Health-Benefits-table.pdf\">deductibles jumped from $3,700 for an individual and $7,400 for a family with a mid-tier plan (PDF)\u003c/a> to \u003ca href=\"https://www.coveredca.com/pdfs/Health-Benefits-table.pdf\">$4,750 and $9,500, respectively (PDF)\u003c/a>. Health Access is sponsoring \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB1208\">another measure\u003c/a> this year to ensure money appropriated for Covered California affordability measures is used for that purpose.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://flo.uri.sh/visualisation/12755159/embed?auto=1\" width=\"800\" height=\"550\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>“One of the most direct and impactful ways we can make sure consumers get health care access right now is by lowering the cost of care,” Linn Gish said. “The 2025 (federal subsidy) sunset was the governor’s main sticking point … but to us, it’s 2023. Why can’t we help people now?”\u003c/p>\n\u003cp>Senate Democrats also rejected delays and cuts to investments in the state’s health care workforce, including a $49.8 million cut to training programs for public health workers. Michelle Gibbons, executive director of the County Health Executives Association of California, said the money was sorely needed after decades of public health budget cuts left the state scrambling to respond to the COVID-19 pandemic.\u003c/p>\n\u003cp>“We can’t even begin to grow the pipeline of microbiologists, lab directors, epidemiologists — very skilled positions — without these programs and investments,” Gibbons said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It’s unclear, however, how feasible the Senate Democrats’ proposal is with the state facing an economic downturn. Most of the cuts avoided are funded through a $6 billion proposed corporate tax hike and $5 billion suspension of a major tax credit, which \u003ca href=\"https://calmatters.org/newsletters/whatmatters/2023/04/california-taxes-budget/\">Newsom rejected within hours of the proposal’s release\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11948505/newsom-breaks-deal-to-lower-price-of-covered-california-lawmakers-move-to-hold-him-to-it","authors":["byline_news_11948505"],"categories":["news_8"],"tags":["news_5164","news_25015","news_32706","news_1054"],"affiliates":["news_18481"],"featImg":"news_11948560","label":"news_18481"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? 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Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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