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Written by: Covered California

Published: 28 December 2022

Created: 28 December 2022

Last Updated: 28 December 2022

With Californians facing the compounding impact of three respiratory illnesses this winter, Covered California is urging the uninsured to sign up for health care coverage before the upcoming Dec. 31 deadline.

Coverage provides access to quality care and protection from unforeseen medical costs, and Covered California is where people can get financial help to lower the cost of their health insurance.

Californians need to sign up before the end of the year in order to have their coverage be effective on Jan. 1.

“Everyone deserves the protection and peace of mind that come with having high-quality, affordable health insurance, and Covered California is urging everyone who needs coverage to check out their options and sign up before the end of the year,” said Jessica Altman, executive director of Covered California. “Once again — whether it is COVID, the flu, RSV or other illnesses — access to health care coverage is essential for every Californian to stay healthy and safe.”

What you need to know

Since the start of the pandemic, California’s health officials have been concerned that COVID-19 and influenza cases may peak at the same time. In addition to those two illnesses, California is also seeing a rise in the number of Respiratory Syncytial Virus (RSV) cases, which can hit younger children especially hard.

“We have seen dramatic increases in COVID-19, the flu and RSV, reminding us once again of the importance of our health and wellbeing,” said Dr. Mark Ghaly, California Health and Human Services secretary and Covered California board chair. “Californians have just a few days left to sign up for a comprehensive health care coverage plan through Covered California that will protect themselves and their family starting on Jan. 1.”

Californians who sign up by Dec. 31 and pay their first bill will have their health insurance take effect on Jan. 1. Covered California’s open-enrollment period runs through Jan. 31, but coverage will not begin until Feb. 1 if a consumer signs up in January.

Significant savings for more than one million uninsured Californians

An estimated one million Californians do not have health insurance and are eligible for financial help to bring the cost of coverage within reach. Of that group, at least 55 percent — or about 568,000 people — could get quality coverage through Covered California or Medi-Cal at no cost.

Right now, 90% of Covered California’s enrollees qualify for the increased financial help available through the Inflation Reduction Act. As a result, two-thirds of Covered California’s consumers are eligible for comprehensive health insurance at a cost of $10 or less per month.

“Regardless of your income, if you need health insurance or even if you’re covered directly through a health insurance company, come to Covered California to see if you can get financial help to make your coverage more affordable,” Altman said.

Under the expanded financial help now available, a 21-year-old in Los Angeles who earns $27,000 a year could get a quality Silver 87 plan — which features low copays and deductibles — for $36 a month. Or they could get a Bronze plan at no cost.

A couple in Oakland earning $45,775 a year could save nearly $700 a month off the cost of their Silver 73 plan, or get a comprehensive Bronze plan at no cost.

Finally, a Sacramento couple earning $83,250 a year could save more than $16,000 a year on quality coverage for themselves and their two children, or they could get a Bronze plan for $67 per month.

New opportunity for 400,000 Californians to enroll in more-affordable coverage

A new rule that went into effect just this month will help 391,000 Californians get access to more-affordable coverage if they have a family member with an offer of employer-sponsored insurance, or ESI.

Previously, these families were ineligible for federal subsidies, and they were forced to either spend a significant amount of their income on health insurance premiums or go uninsured. Now they are eligible for financial help through Covered California that will lower the cost of their coverage.

The example below depicts a family of four with an annual household income of $50,000 who pays $800 a month for their coverage, or nearly 20 percent of their income.

The new rule takes the affordability threshold (9.12 percent in 2023), which had previously been applied only to the employee, and now extends it to the entire family. In this case, while the cost of the employee’s coverage is below the threshold, the cost to cover the family is no longer considered affordable. As a result, the employee’s spouse and children are now eligible for financial help and would save $425 a month — or $5,100 a year — by enrolling in a Covered California plan.

“The new rule means that families that were either forced to spend a significant amount of their income to be a part of their loved one’s health plan, or go uninsured, can now get more-affordable coverage through Covered California,” Altman said.

In order to determine whether Californians can benefit from the new rule, Covered California unveiled a new affordability tool and worksheet earlier this month, which can help people see if they or their family members qualify for financial help. The affordability tool and worksheet are also available in Spanish.

In addition to the tool, consumers can also contact an agent or certified enroller, visit our support page or use Covered California’s Help on Demand service to have an enroller contact them within 15 minutes.

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Written by: MCHC Health Centers

Published: 23 December 2022

Created: 23 December 2022

Last Updated: 23 December 2022

NORTH COAST, Calif. — MCHC Health Centers is pleased to announce the arrival of Dr. Matthew Swain as the new chief medical officer.

Dr. Swain, who began his new role in November, oversees MCHC’s clinical practices, including mental, dental and behavioral health.

In addition to being a member of the executive team, Dr. Swain continues to see patients, as is the case for all clinical leaders at MCHC.

Dr. Swain comes to Mendocino County from Alaska, where he spent the last two and a half years practicing family medicine on the Kenai Peninsula in the small coastal town of Homer.

Prior to that, Dr. Swain spent three years as the chief of primary care for Alaska’s Veterans Administration Healthcare System, where his duties included clinical and administrative supervision of 30 providers spread across six clinics.

Before moving to Alaska, Dr. Swain, a veteran of both the Navy and Marines, practiced medicine and held a number of leadership roles at Camp Lejeune in North Carolina.

While he is accustomed to small-town living, he admits that Northern California and Southern Alaska are very different — and that by comparison, Ukiah feels pretty big.

“In Alaska, it sometimes seemed like we had just as many moose as people,” Dr. Swain said. “I think the most we ever had in our yard at one time was six.” Then he asked, “Do you know why the stores in Homer don’t have automatic sliding doors? Because they don’t want the moose walking in. I’m not kidding.”

Although he speaks highly of his time in Alaska, he explained that he and his wife, a nurse leader, were ready for a new adventure, and after a nationwide search, they chose MCHC.

In addition to the small-town atmosphere and beautiful natural setting, Dr. Swain chose the area because the MCHC team was so dedicated to its mission of providing the highest quality healthcare for everyone in the community.

“When I first visited, everyone was smiling, engaged, and clearly invested in their jobs; people weren’t just punching timecards,” he said.

He was also drawn in by MCHC’s team-based approach to care. “Team-based care means having a small group of dedicated providers and support staff who know you and your health history,” Dr. Swain explained.

As a family physician, he has always held a holistic view of wellness, one that integrates a person’s physical and emotional health, so the way MCHC’s structure encourages collaboration was another good fit for Dr. Swain.

“Being able to walk down the hall and consult with providers across different disciplines is so much better than reading notes and going back and forth over the phone. Multiple perspectives improve care. No one person has all the answers all the time,” he said.

To be a good physician and leader, Dr. Swain’s philosophy is that you have to be genuinely interested in patients and what is going on with them — even outside of medicine. A lot of factors affect health, and lab tests rarely tell the whole story. Mood, family, and work all play a role, too.

Dr. Swain explained, “You have to be willing to get into all the little details, because the little details are often what make the difference between living a healthy, comfortable life or not. When a patient knows you care about what they care about, they’re a lot more likely to work with you to maximize their quality of life.”

As a leader, Dr. Swain says he is responsible for clearing obstacles and providing support to employees. “It’s my responsibility to take care of everyone who takes care of patients, whether they’re providers or the staff who support, whether they are answering phones or cleaning treatment rooms,” he explained.

MCHC CEO Rod Grainger said, “It is not often you find a leader that fits so well into your existing team. With his leadership philosophies, his skills and experience, as well as his personality, Matt is winning over the team and already having a positive influence on the culture of our organization. His personal mission aligns with our mission for both our employees and our patients. I am thrilled to have him on board.”

Regardless of what he is doing at any given moment, Dr. Swain says his ultimate focus is providing excellent, value-based healthcare to the local community. Sometimes that means treating patients directly; other times that means caring for the providers who care for the patients so they are free to do their jobs.

“MCHC employees are mission-driven and committed to meeting the emerging needs of patients in the wake of the COVID-19 pandemic. It’s an honor to be the chief medical officer here and I look forward to helping providers and staff grow and succeed every single day,” he said.

MCHC Health Centers includes Hillside Health Center and Dora Street Health Center in Ukiah, Little Lake Health Center in Willits, and Lakeview Health Center in Lakeport. It is a community-based and patient-directed organization that provides comprehensive primary healthcare services as well as supportive services such as education and translation that promote access to healthcare.

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Written by: Department of Insurance

Published: 06 December 2022

Created: 06 December 2022

Last Updated: 06 December 2022

SACRAMENTO — Insurance Commissioner Ricardo Lara announced that Essilor Laboratories of America Inc. has agreed to a $23.8 million settlement in a lawsuit which alleged the company violated the Insurance Frauds Prevention Act.

The suit alleged Essilor provided kickbacks and other unlawful incentives to eye care providers that ultimately hurt consumers by unfairly driving them toward more expensive services.

Essilor manufactures, markets, and distributes optical lenses and equipment used to produce optical lenses throughout California and the nation.

“This settlement is an important victory for consumers and patients who were the targets of corporate greed,” said Commissioner Lara. “Health insurance fraud causes billions of dollars of premium losses annually, resulting in increased cost to Californians. This settlement sends a strong signal that fraudulent practices that hurt California consumers will not be tolerated and will be prosecuted to the full extent of the law. It also will restore key protections for eyecare patients so they receive care and recommendations that are in their best interest.”

This settlement brings to a close a 2016 whistleblower lawsuit brought against Essilor. After investigating the allegations, the Commissioner filed a complaint in intervention in 2021.

The lawsuit alleged that Essilor provided unlawful kickbacks to eye care providers, with an up-front payment of tens of thousands of dollars, or sometimes hundreds of thousands of dollars, in exchange for these providers’ promises to send business to Essilor for a period of anywhere between three to five years.

The providers were free to use the up-front payment from Essilor in any manner that they chose so long as they hit the volume requirements pursuant to the agreement.

Additionally, the lawsuit alleged Essilor further provided kickbacks to California eye care providers through a program called “PracticeBuilder” where providers were given cash payments for using Essilor lenses and laboratory services.

The cash payments through the PracticeBuilder program were done to reward the eye care providers who prescribed and dispensed Essilor’s more expensive lenses and coatings and to use its laboratory services.

Unlawful incentives, like those alleged in the lawsuit, are prohibited under the Insurance Frauds Prevention Act as these illegal acts can, and do, influence medical decision making. California laws are in place to protect patients and encourage medical decision makers to act solely in the best interest of their patient.

The lawsuit further alleges Essilor knowingly submitted false claims to California private payors, including insurance companies, health care savings plans, and vision benefit organizations.

The resolution is the result of a collaborative prosecution between the Commissioner and the whistleblower’s counsel, Baron & Budd, P.C., The Weiser Law Firm, and Keller Grover, LLP.