California Health Benefit Exchange Decision Roadmap

1. California Health Benefit ExchangeDecision Roadmap Peter V. Lee November 15, 2011

2. Major Issues and Working Contractor Engagement Timeline 1

3. Scope of Background Material To Be Developed 1) Legal Scope • Regulatory requirements • Prohibited approaches • Allowable alternatives 2) “Just the Facts” • Current California activities • California and National relevant data 3) Stakeholder Perspectives 4) Options and Recommendations 5) Detailed budget and timeline for Level II grant

4. Engagement and Input Processes • Stakeholder Engagement; small and large group across all stakeholders. • Develop questions for input in consultation with Exchange Stakeholder Advisory Workgroups. • Solicitation by the Exchange for input on key questions. • Exchange engagement of expert consultants to gather data and provide options. • Review of options with stakeholder input at Exchange Board Meetings and other forums.

5. California Affordable Coverage Enrollment System RFP Development and Proposal Evaluation: Working Timeline 4

6. Marketing, Promotion and Outreach Partial Issue List Potential Stakeholder Questions • What sales, outreach and assistance channels are most effective for which populations? • How can the Exchange marketing efforts be best coordinated with national and state government partners and private sector partners (e.g., providers, plans, foundations)? Resource: New Contractor (s) for Research; New Contractor for Outreach and Communications • Sales channels • Special population outreach • Costs and flows • Focus groups • Navigator roles • Scope of work for Navigators, Brokers/Agents, etc. • Certification and licensing • Payment for Navigators • Exchange need for immediate communications support 5

7. Navigators, Agents and Brokers • Potential Stakeholder Questions: • What minimum criteria should navigators meet? What training/certification requirements should navigators meet? • What performance standards should navigators have (e.g., requirements for case volume, language access, etc.)? • What responsibilities should navigators have relative to enrollment in non-Exchange health programs including Medi-Cal? What responsibilities/linkages to other social service programs? • How will the work of navigators be coordinated with other consumer assistance groups to provide effective, non-redundant services? • What should be the terms of participation be for agents and brokers in the SHOP and individual exchange? • What are the potential payment amounts/levels for brokers in the SHOP and individual exchange? • Should payment to brokers be made by the Exchange or plans in the SHOP and individual exchange? • What is the relationship of brokers to navigators? • What is the relationship of brokers to public health care program and/or non-health social service programs? Resource: New Contractor for Outreach and Communications 6

8. Enrollment & Information Technology Partial Issue List Potential Stakeholder Questions • What roles should the following entities play in Exchange enrollment, what are payment options and appropriate outcome measures for their work: • Community/consumer groups • Counties • Brokers/agents • Providers/community clinics • Health plans • What language and accessibility standards should the Exchange use and require use of? • What role should the Exchange play in the enrollment of any non-health service programs? • What process can be used to minimize gaps in coverage and facilitate transitions between programs? Resources: ClearBest; New Contractor; PCG; New Contractor(s) for Outreach Issues • Cost allocation between Exchange, and partners • County role and potential payments for enrollment • Processes for design and scope minimizing gaps in coverage • Design and scope of call-center functions • Assuring language and diversity capacity of service providers • Provisions for in-person services • Enrollment estimates 7