Getting Insured Through Covered California

Jessica Altman

Executive Director, Covered California

Manoj Govindaiah

Managing Attorney, Immigrant Legal Defense

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Immigrant Legal Defense (ILD)

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ILD is a nonprofit agency dedicated to providing immigration legal services. ILD’s mission is to promote justice through the provision of legal representation to underserved immigrant communities.

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• Through our higher education partnerships, we serve students, staff, faculty, immediate family members & recent alumni, at 9 CSU and 34 CCC campuses.
• We provide immigration consultations and case representation
• All of our immigration services are free & confidential.
• Our services include: DACA, family petitions, U & T visas, VAWA, detained and non-detained deportation (court) defense, asylum, applications for lawful permanent resident status, and citizenship.

Public Charge

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• Immigration law requires an immigration officer to consider whether you will become a “public charge” when considering your application for immigration benefits.
• Not all application types are subject to public charge.

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• The officer will look at your age, health, income, education, work experience, etc. to make this determination.
• As part of the evaluation, the officer will consider whether you have used public benefits.
• Some immigration applications require affidavits of support, which also factor into the public charge analysis.

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Covered California & Public Charge

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Use of public benefits does NOT automatically make a person a public charge.

• The key factor is whether you appear likely to rely on benefits in the future.

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• Benefits that impact public charge:
• Cash Assistance programs that help maintain income (like SSI, CalWORKS, CAPI)
• Long term institutionalized care covered by Medi-Cal

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• Use of Covered California health insurance IS NOT a public charge issue. Neither is use of Medi-Cal.

Litigation against ACA coverage expansion

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• President Biden issued new regulations in May 2024 expanding eligibility for coverage under the ACA.

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• In August, 19 states filed a lawsuit in federal court in North Dakota to stop the ACA expansion for DACA recipients. Kansas, et al v. United States, 1:24-cv-00150 (D. N.D. 2024).

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• On December 9, 2024, the judge issued a preliminary injunction that prevents the new regulations from going into effect.
• Decision is limited to only the 19 plaintiff states.
• Regulations can still move forward in California!

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COVERED CALIFORNIA OVERVIEW

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THE AFFORDABLE CARE ACT

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The Patient Protection and Affordable Care Act (ACA) was signed into federal law in March 2010. Three core provisions of the Affordable Care Act included:

• Health Benefit Exchanges and Federal Subsidies:�The ACA created federal and state-based exchanges, or marketplaces for consumers to buy health insurance and receive financial assistance if they qualify for it.
• Insurance Market Reforms:�The ACA changed the insurance market to allow for guaranteed issue and renewal regardless of pre-existing conditions; no annual or lifetime limits; coverage for essential health benefits; and dependent coverage up to age 26.
• Medicaid Expansion:�The ACA expanded Medicaid to low-income childless adults.

WHAT IS COVERED CALIFORNIA?

• Covered California is the California state-based exchange, or marketplace under the Affordable Care Act, where Californians can purchase quality, comprehensive, brand name health and dental insurance for themselves and their families and qualify for financial help based on annual income.

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• It is the only place where eligible Californians can receive federally-funded financial help to pay for healthcare premiums.

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• Financial help includes tax credits paid in advance to the health plans — also known as Advanced Premium Tax Credits (APTC) and cost-sharing reductions (CSR). It also includes California specific cost-sharing reduction assistance.
• Covered California serves consumers in the individual market, or those who don’t qualify for Medi-Cal, Medicare, student health plans or employer insurance.

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WHAT IS COVERED CALIFORNIA?

• Covered California has roughly 1.8 million enrollees and over 90% of these enrollees receive financial assistance.

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• No Wrong Door Approach: Medi-Cal and Covered California use the same application for health coverage. This means that a consumer can apply and find out which program they qualify for using the CalHEERS application. In some cases, a household can qualify for both programs; known as a mixed household.

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MARKETPLACE BENEFITS AND COVERAGE LEVELS

The Affordable Care Act (ACA) requires that products sold in the individual market cover 10 essential health benefit categories*. 

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*Copays and deductibles may apply to these services

COVERED CALIFORNIA MENTAL AND BEHAVIORAL HEALTH BENEFITS AND COVERAGE

• As a part of the Essential Health Benefits, Covered California requires all health plans to provide mental health and substance use disorder services, including behavioral health treatment.

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• California law requires all commercial health plans to provide coverage for medically necessary treatment of mental health and substance use disorders at the same cost as physical health conditions.

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• Covered California health plans must cover all medically necessary treatments including:
• Sessions with a Therapist
• Medication to manage the condition
• Outpatient Intensive Treatment
• Inpatient Residential Treatment

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• If a Covered California enrollee cannot find an appropriate mental health provider in their QHP network, the QHP must arrange and pay for out-of-network services at no additional cost to the enrollee.

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COVERED CALIFORNIA MENTAL AND BEHAVIORAL HEALTH BENEFITS AND COVERAGE

• QHPs cannot charge more for mental health and substance use disorder services than for physical health conditions. This includes enrollee cost-sharing obligations for:

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• Co-Pays
• Deductibles
• Maximum Annual and Lifetime Benefits
• Other Out-of-Pocket Expenses

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2025 COVERED CALIFORNIA HEALTH PLANS

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• Covered California provides quality health coverage from private health insurance companies.

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• These 12 companies meet all the state and federal requirements for health plans, plus additional contractual requirements set by Covered California.

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• Health companies offer one or more of these products: PPO, HMO, and/or EPO; and a wide variety of doctors and hospitals.

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2025 COVERED CALIFORNIA HEALTH PLAN BY REGION

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2025 FAMILY DENTAL AND VISION COMPANIES

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All health plans include dental care for children at no extra cost.

Adults can purchase a family dental plan when they enroll in a Covered California health insurance plan.

• There must be at least one adult (age 19 or older) enrolled in �a family dental plan for a child in the family to enroll. (Not all adults in the household are required to enroll.) If a family chooses to enroll children in a family dental plan, all children younger than 19 who live in the household must enroll.

https://www.coveredca.com/individuals-and-families/getting-covered/dental-coverage/family/

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Children under age 19 get free vision care included with their parent’s Covered California health plan.

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Adults can enroll directly with one of our three contracted vision companies.

https://www.coveredca.com/vision/adult/

https://www.coveredca.com/vision/childrens-vision/

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COVERED CALIFORNIA OPEN ENROLLMENT AND SPECIAL ENROLLMENT PERIOD

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COVERED CALIFORNIA ENROLLMENT WINDOWS

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• Open Enrollment: Eligible Californians can sign-up for Covered California between November 1 and January 31. Unless qualified for “special enrollment,” individuals and families cannot enroll outside of the open enrollment period.

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• Special Enrollment: Short time window in which eligible Californians can sign-up for Covered California. Special Enrollment can only be triggered by a change of circumstance (loss of employment, marriage, birth, relocation).

PROMOTING ENROLLMENT AND HEALTH LITERACY:�“LET’S TALK HEALTH” CAMPAIGN

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STATEWIDE MEDIA CAMPAIGN WITH A FOCUS ON HEALTH LITERACY

• Simplify the complexity of health insurance and empower consumers to enroll, regardless of language, ethnicity, region or income.
• Leverage new partners, as well as our incredible network of enrollers and navigators to deepen reach.
• Multi-layered campaign messaging covering enrollment, record-level of affordability support, and DACA.
• Media, stakeholder elected official and community leader engagement.

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IMMIGRANT CATEGORIES ELIGIBLE FOR COVERAGE IN CALIFORNIA

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IMMIGRANT CATEGORIES ELIGIBILE FOR COVERAGE IN CALIFORNIA

• Under the Affordable Care Act, most immigrants qualify for health coverage through Covered California, including the following groups:
• Lawful permanent residents (green card holders).
• Lawful temporary residents.
• Persons fleeing persecution, including refugees and asylees.
• Other humanitarian immigrants, including those granted temporary protected status.
• Work Visa holders (including H-1, J-1, O, P, R visas)
• Student Visa holders (including F and M visas)
• Deferred Action for Childhood Arrivals
• Starting Jan. 1, 2024, adults in California ages 26 through 49 now qualify for Medi-Cal, regardless of their immigration status. All other Medi-Cal eligibility rules, including income limits, will still apply.
• Both lawfully present and not lawfully present individuals can apply through Covered California to see if they are eligible for a health plan through Covered California or Medi-Cal. There is no “waiting period” or “five-year bar.”

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IMMIGRANT CATEGORIES ELIGIBLE FOR COVERED CALIFORNIA PROGRAMS

Documents to confirm eligibility for Covered California Programs:

• Permanent Resident Card (“Green Card,” I-551)
• Employment Authorization Card (I-766)
• Machine Readable Immigrant Visa (with Temporary I-551 Language)
• Arrival/Departure Record (I-94, I-94A) issued by U.S. Citizenship and Immigration Services
• Certificate of Eligibility for Non-immigrant (F-1) Student Status (I-20)
• Notice of Action (I-797)

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COVERED CALIFORNIA ENROLLMENT JOURNEY

DACA Recipients - 2025 Open Enrollment

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DEFERRED ACTION FOR CHILDHOOD ARRIVALS (DACA) RECIPIENT ENROLLMENT

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IMPLEMENTING EXPANSION FOR RECIPIENTS OF�DEFERRED ACTION FOR CHILDHOOD ARRIVALS (DACA)

• On May 2, 2024, CMS finalized an expansion of the definition of “lawfully present” – a necessary condition for enrolling through the insurance marketplaces – to include recipients of Deferred Action for Childhood Arrivals (DACA).
• Beginning November 1, 2024, DACA recipients in California are eligible to apply for coverage through the marketplace and receive federal and state tax credits in the form of Advanced Premium Tax Credits (APTC) and cost sharing reductions to make coverage more affordable.
• While there is pending litigation challenging this expansion, the policy currently remains effective in California. Accordingly, DACA recipients are still eligible to enroll in coverage and qualify for financial assistance through Covered California. Covered California will continue to monitor any updates and work closely with community partners to keep individuals well-informed.

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UNINSURED DACA RECIPIENTS ELIGIBLITY FOR SUBSIDIES IN CALIFORNIA

Outreach & Sales Open Enrollment 2025 Kickoff Meeting | September 2024

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~40,000

• California Simulation of Insurance Markets (CalSIM) model Estimates
• UC Berkeley Labor Center's analysis using CalSIM
• Rough estimate: 40,000 uninsured Californians are DACA recipients
• Would now qualify for Covered California subsidies
• Enrollment Impact
• Estimated 30,000 uninsured DACA recipients may enroll
• Assumption: Take-up rates similar to general Californian population
• Importance of Subsidized Coverage
• Acts as important safety net for DACA recipients
• Aligns with benefits to citizens and lawfully present individuals
• Helps in closing health insurance gaps due to income fluctuations or job transitions

*UC Berkeley Labor Center Publication: Extending Covered California subsidies to DACA recipients would fill coverage gap for 40,000 Californians

https://www.uscis.gov/sites/default/files/document/data/Active_DACA_Recipients_Dec_FY23_qtr1.pdf

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DACA ENROLLMENT THROUGH COVERED CALIFORNIA

Outreach & Sales Open Enrollment 2025 Kickoff Meeting | September 2024

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IMMIGRATION STATUS DROPDOWN FOR DACA RECIPIENTS

• No changes to the application process are expected.

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• "Granted Deferred Action for Childhood Arrivals - (DACA)" is already listed in the immigration status drop down menu.

Outreach & Sales Open Enrollment 2025 Kickoff Meeting | September 2024

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DOCUMENT CATEGORY DROPDOWN FOR DACA RECIPIENTS

During the application process, applicants are asked to provide information to confirm that they have the eligibility to enroll in Covered California.

Outreach & Sales Open Enrollment 2025 Kickoff Meeting | September 2024

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DACA RECIPIENTS UNABLE TO PROVIDE DOCUMENTATION

• DACA recipients may be required to submit supporting documents. In this case, applicants will receive conditional eligibility, assuming all other criteria are met.
• A 95-day Reasonable Opportunity Process (ROP) will be granted to submit necessary documents.
• During ROP, DACA recipients will have access to healthcare coverage enrollment.
• The ROP process for DACA recipients will mirror that of all other applicants.

Outreach & Sales Open Enrollment 2025 Kickoff Meeting | September 2024

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COVERED CALIFORNIA FOR DACA RECIPIENTS

Outreach & Sales Open Enrollment 2025 Kickoff Meeting | September 2024

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CALIFORNIA INDIVIDUAL MANDATE PENALTY & EXEMPTIONS

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Effective January 1, 2020, California residents must either:

• Have qualifying health insurance coverage, or
• Pay a penalty when filing a state tax return, or
• Get an exemption from the requirement to have coverage.
• Most exemptions can be claimed through the Franchise Tax Board.
• Covered California grants some exemptions for general hardship, affordability hardship, and religious conscience.

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The penalty does not apply to those who are not eligible for health insurance coverage, for examples, those not lawfully present. DACA recipients are now subject to the penalty.

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The penalty for not having coverage the entire 2023 year will be at least $900 per adult and $450 per dependent child under 18 in the household when you file your 2023 state income tax return in 2024.

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HOW TO ENROLL IN COVERED CALIFORNIA

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HELPING CONSUMERS ENROLL

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COVERED CALIFORNIA ENROLLMENT PARTNERS

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• More than 11,000 insurance agents have been trained to sell Covered California products and are consistently the largest channel for enrollment.
• To spur enrollment, Covered California engages with licensed insurance agents and navigators who offer free confidential assistance.
• Consumers can get enrollment assistance in 16 languages from Covered California licensed insurance agents.
• Consumers can go to this site to find insurance agents licensed by Covered California.
• 95% of all Californians are within a 15-minute drive from one of Covered California’s storefront locations.

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*Data as of 2/22/2023

• Covered California awards up to $11.3 million annually to support more than 100 community organizations through the Navigator Program.
• Covered California’s Navigator Program is a partnership with community organizations across the state who have experience in reaching and assisting California’s diverse populations and have proven success enrolling consumers in health care programs.

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HOW TO GET FREE IMMIGRATION LEGAL SERVICES

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Legal Services for all CSU and CCC Campuses

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Services are:

• Available in client’s best language.
• Free and confidential.
• Available to individuals regardless of their status.
• Available to students, staff, faculty, (and for their immediate family members and recent alumni for CSUs).

Where CSU students can receive Immigration Help? �

For the other 14 CSU campuses:

https://www.calstate.edu/residency

For ILD’s 9 CSU Campuses (San Jose, San Francisco, East Bay, Maritime, Stanislaus, Fresno, Bakersfield, Monterey Bay, and Cal Poly SLO): https://calendly.com/csulegalservices/ild

Where community colleges can receive Immigration Help?

For ALL CCC campuses, schedule an appointment:

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https://findyourally.com/ 

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QUESTION PERIOD

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THANK YOU!

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