California’s Largest Public Health Care Purchasers Unite to Address Gaps in Childhood Immunizations and Colorectal Cancer Screenings Due to the COVID-19 Pandemic

• Covered California, the Department of Health Care Services and CalPERS are joining together to require their health insurance companies to address significant drops in preventive care due to the COVID-19 pandemic, which has exacerbated racial and ethnic health disparities across the state.
• Together these three purchasers represent about 40 percent of California’s overall population.
• Covered California added performance goals for health plans, requiring them to return to pre-pandemic levels of childhood vaccinations and colorectal cancer screenings by the end of 2021.

SACRAMENTO, Calif. — Covered California, the Department of Health Care Services (DHCS) and CalPERS are taking the lead in addressing gaps in preventive care created by COVID-19 and will pay specific attention to racial and ethnic disparities that have been exacerbated by the pandemic. Covered California, DHCS — which operates the state’s Medi-Cal program — and CalPERS announced complementary efforts to ensure that everyone covered by the programs gets vaccines to prevent COVID-19 as they become available while addressing preventive care gaps caused by patients not getting needed services.

“As we focus on the immediate health and economic impacts of COVID-19, we must be proactive to address downstream effects the pandemic can have on the health of Californians and our communities,” said Peter V. Lee, executive director of Covered California. “Taking action now, on childhood immunizations and colorectal cancer screenings, is an investment in future good health, and these policies are intended to help avoid a surge of bad health outcomes in the future.”

Covered California will require its 11 health insurance companies to reach pre-pandemic levels of childhood immunizations and colorectal cancer screenings by the end of 2021 and to exceed those numbers by the end of 2022.

Dr. Alice Hm Chen, Covered California’s chief medical officer, said the motivation to act was data showing that COVID-19 has led to a sharp drop-off in primary and preventive care. At the same time, the pandemic has had a strikingly disproportionate impact on people of color. 

“Coverage is a means to getting better care and ideally better outcomes,” Dr. Chen said. “We wanted not only our health plans, but all health plans and providers in the state, to address the impact of COVID-19 on preventive care. Our hope is that by working collectively, we can make up critical ground that was lost over the past year.”

Data from California’s Department of Public Health shows that vaccination rates in the state have fallen. As of November 2020, 12 percent fewer children had received their first dose of the MMR (measles-mumps-rubella) vaccine compared to the year before, and 20 percent fewer adolescents received their Tdap (tetanus) shot. Dr. Chen said Covered California and its fellow public purchasers, DHCS and CalPERS, felt a sense of shared urgency to act.

“DHCS shares this focus on equity and childhood wellness, and we are finalizing a roadmap to reduce health inequities in Medi-Cal with measures to recognize health disparities among beneficiaries,” said DHCS Director Will Lightbourne. “Early in the pandemic, we identified growing gaps in well-child visits and immunizations. We are committed to closing those gaps and others, in part through our ongoing requirement that Medi-Cal managed care plans conduct performance-improvement efforts on youth preventive health care.”

“As the largest purchaser of public employee benefits in California, CalPERS is committed to providing high-quality, equitable care to our members. Our data shows that the use of preventive care, including cancer screenings and immunizations, has declined during the COVID-19 pandemic,” said Don Moulds, CalPERS chief health director. “Together, with Covered California and DHCS, we are taking action to close gaps in care created by the pandemic, and are working with our health plans to ensure our members have access to much needed chronic care and preventive care services.”

Dr. Chen said colorectal cancer is a leading cause of cancer death and a source of significant racial and ethnic disparities. Data from the Epic Health Research Network found that at the onset of the pandemic, colorectal cancer screenings had declined by nearly two-thirds compared to the historical average. Dr. Chen said those trends need to be reversed immediately.

“As a cancer that is amenable to prevention rather than just early detection, it’s critical we get people between the ages of 50 and 75 screened, and it’s a process that can be started without an in-person visit,” Dr. Chen said. “Treatment for colorectal cancer in its earliest stage can lead to a 90 percent survival rate after five years.”

Lee said these provisions chart a path for future collaboration for a bolder shared agenda in support of quality, equity and delivery system transformation.

“Covered California is proud to be joining with both other major purchasers and the health plans. We put a spotlight on core issues of health care equity and quality that matters, and they stepped up for the communities they serve,” Lee said. 

American Rescue Plan Special-Enrollment Period

The announcement comes during Covered California’s special-enrollment period in support of the American Rescue Plan. The new and expanded financial help that is now available will allow the uninsured to sign up for coverage at dramatically lower premiums, with many being eligible for high-quality plans that cost as little as $1 per month. Californians who are insured directly through a health insurance carrier can also switch to Covered California, often with the same carrier and coverage level, and save hundreds of dollars a month.

Californians are encouraged to check their health care options, even if they have checked in recent months or years, to see how affordable coverage can be. On CoveredCA.com, consumers can easily see exactly how they can benefit from the new law. Consumers just need to enter their ZIP code, household income and the ages of people in their household to see their monthly cost and the health insurance options in their area.

Those interested in learning more about their coverage options can also:

• Visit www.CoveredCA.com.
• Find local insurance agents or individuals in Navigator organizations who provide free and confidential assistance over the phone or in person, in a variety of languages.
• Get a call from certified enroller. Covered California will have someone reach out to the consumer to help them for free.
• Call Covered California at (800) 300-1506.

About Covered California

Covered California is the state’s health insurance marketplace, where Californians can find affordable, high-quality insurance from top insurance companies.

Covered California is the only place where individuals who qualify can get financial assistance on a sliding scale to reduce premium costs. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Depending on their income, some consumers may qualify for the low-cost or no-cost Medi-Cal program.

Covered California is an independent part of the state government whose job is to make the health insurance marketplace work for California’s consumers. It is overseen by a five-member board appointed by the governor and the Legislature. For more information about Covered California, please visit www.CoveredCA.com.

About the Department of Health Care Services

The California Department of Health Care Services (DHCS) is the backbone of California’s health care safety net. It provides access to affordable, integrated, high-quality health care, including medical, dental, mental health, substance use treatment services and long-term care. DHCS funds health care services for about 13 million Medi-Cal beneficiaries and is the largest health care purchaser in California. It collaborates with the federal government and other state agencies, counties, and partners to invest more than $100 billion for the care of low-income families, children, pregnant women, seniors, and persons with disabilities. For more information about DHCS, please visit www.dhcs.ca.gov.

About CalPERS

For more than eight decades, CalPERS has built retirement and health security for state, school, and public agency members who invest their life work in public service. Its pension fund serves more than 2 million members in the CalPERS retirement system and administers benefits for more than 1.5 million members and their families through its health program. It is the largest defined-benefit public pension in the U.S. CalPERS’ total fund market value currently stands at approximately $446 billion. For more information, visit www.calpers.ca.gov.