California’s Low Income Health Programs (LIHPs): An Important “Bridge” to Expanded Coverage in 2014

Local governments throughout California are taking advantage of federal funding to expand coverage to some uninsured residents and get an important head start in preparing their enrollment systems for the expansion of coverage in 2014. California Healthline recently highlighted this early progress in expanding coverage under the Affordable Care Act.

California received a Section 1115 Waiver from the Centers for Medicare and Medicaid Services (CMS) to implement a $10 billion "Bridge to Reform" program. A key piece of this new initiative is the Low Income Health Program (LIHP). LIHP gives counties the option to provide coverage, with the help of a federal match, to uninsured Californians who have incomes less than 200 percent of the federal poverty level ($22,340 for an individual in 2012). The state expects LIHPs to cover over half a million people. LIHP was launched in 10 of California's 58 counties last year, and more than 250,000 residents have already enrolled.

 While expanding coverage to previously uninsured residents is an important short-term result of the program, LIHP is also intended to help California prepare for the coverage expansion in 2014.

• The outreach efforts for LIHP will provide the state with invaluable lessons for the future. California will need to develop a variety of strategies to successfully engage the state’s diverse population and maximize enrollment during the expansion in 2014. Communities participating in LIHP will be able to use the program as a way to build enrollment assistance networks and experiment with innovative new outreach strategies.

• LIHP can be a platform for developing and testing a modern, online enrollment system. In 2014, California will need to have an enrollment system that provides a consumer-friendly website that seamlessly coordinates eligibility and enrollment across Medicaid, CHIP, and private coverage available through the exchange. LIHP counties are beginning to assess the work that will need to be done to move from a paper-based application to an electronic one, and to coordinate enrollment between different county and state agencies.

• LIHP provides an opportunity to automatically enroll over half a million people in the Medicaid expansion or coverage through California’s Health Benefits Exchange on day one. 2 million uninsured Californians will be eligible for coverage through the Medicaid expansion in 2014. Enrolling a significant portion of these people in LIHP now will help the state better manage the sheer volume of newly eligible people come 2014.

• The federal investment will help communities prepare their safety net. Demand for health care services is expected to grow in 2014. The gradual and early ramp-up of enrollment with LIHP means that safety-net providers have additional resources and time to expand their capacity.

In October of last year, the Blue Shield of California Foundation sponsored a conference in Sacramento for LIHP personnel and other key stakeholders. (Materials from this conference are available here.) A generous supporter of LIHP, the foundation provided grants to local governments and organizations throughout California to help implement the program and identify best practices for outreach and enrollment efforts.

Each county's LIHP is unique, so we'll be taking a look at a few programs from different counties in the coming weeks. We will explore how they are tackling eligibility and enrollment challenges and the lessons they have to share with other states.