2023 California Code › Welfare and Institutions Code - WIC › DIVISION 9 - PUBLIC SOCIAL SERVICES › PART 3 - AID AND MEDICAL ASSISTANCE › CHAPTER 7 - Basic Health Care › ARTICLE 3 - Administration › Section 14102.5.

14102.5. (a) The department shall, in collaboration with the Exchange, the counties, consumer advocates, and the Statewide Automated Welfare System consortia, develop and prepare one or more reports that shall be issued on at least a biannual basis and shall be made publicly available within 90 days following the end of each reporting period, for the purpose of informing the California Health and Human Services Agency, the Exchange, the Legislature, and the public about the enrollment process for all insurance affordability programs. The data within the reports shall be aggregated and calculated on at least a quarterly basis. The reports shall comply with federal reporting requirements and shall, at a minimum, include the following information, to be derived from, as appropriate depending on the data element, CalHEERS, MEDS, or the Statewide Automated Welfare System:
(1) For applications received for insurance affordability programs through any venue, all of the following:
(A) The number of applications received through each venue.
(B) The number of applicants included on those applications.
(C) Applicant demographics, including, but not limited to, gender, age, race, ethnicity, and primary language.
(D) The disposition of applications, including all of the following:
(i) The number of eligibility determinations that resulted in an approval for coverage.
(ii) The program or programs for which the individuals in clause (i) were determined eligible.
(iii) The number of applications that were denied for any coverage and the reason or reasons for the denials.
(E) The number of days for eligibility determinations to be completed.
(2) With regard to health plan selection, all of the following:
(A) The health plans that are selected by applicants enrolled in an insurance affordability program, reported by the program.
(B) The number of Medi-Cal enrollees who do not select a health plan but are defaulted into a plan.
(3) For annual redeterminations conducted for beneficiaries, all of the following:
(A) The number of redeterminations processed.
(B) The number of redeterminations that resulted in continued eligibility for the same insurance affordability program.
(C) The number of redeterminations that resulted in a change in eligibility to a different insurance affordability program.
(D) The number of redeterminations that resulted in a finding of ineligibility for any program and the reason or reasons for the findings of ineligibility.
(E) The number of days for redeterminations to be completed.
(4) With regard to disenrollments not related to a redetermination of eligibility, all of the following:
(A) The number of beneficiary disenrollments.
(B) The reasons for the disenrollments.
(C) The number of disenrollments that are caused by an individual disenrolling from one insurance affordability program and enrolling into another.
(5) The number of applications for insurance affordability programs that were filed with the help of an assister or navigator.
(6) The total number of grievances and appeals filed by applicants and enrollees regarding eligibility for insurance affordability programs, the basis for the grievance, and the outcomes of the appeals.
(b) The department shall collect the information necessary for these reports and develop these reports using data obtained from the Statewide Automated Welfare System, CalHEERS, MEDS, and any other appropriate state information management systems.
(c) For purposes of this section, the following definitions shall apply:
(1) “CalHEERS” means the California Healthcare Eligibility, Enrollment, and Retention System developed under Section 15926.
(2) “Exchange” means the California Health Benefit Exchange established pursuant to Title 22 (commencing with Section 100500) of the Government Code.
(3) “Statewide Automated Welfare System” means the system developed pursuant to Section 10823.
(4) “MEDS” means the Medi-Cal Eligibility Data System that is maintained by the department.
(Amended by Stats. 2017, Ch. 511, Sec. 24. (AB 1688) Effective January 1, 2018.)