This dataset includes the total number of newly eligible individuals by Insurance Affordability Program (IAP), by reporting period. IAPs include Medi-Cal, Covered California subsidized and unsubsidized Qualified Health Plans (QHP), and the Medi-Cal Access Program (MCAP). Covered California subsidized and unsubsidized QHP newly eligible data includes those who selected and enrolled in a QHP, and paid their first premium. This dataset is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.

This dataset includes the number of individuals who have filed an appeal for a subsidized Covered California Qualified Health Plan (QHP), Medi-Cal, or a combination of both eligibility determinations by year and quarter. Appeals may be filed by an appellant for determinations that resulted in a denial, eligibility, or discontinuance of coverage. A denial is defined as an eligibility determination at application that resulted in a denial of coverage. An appeal regarding an eligibility determination may be filed when the appellant disputes the type of program eligibility. A discontinuance is when an individual is no longer eligible for Medi-Cal or Covered California QHP. Appeals may be filed for cases involving mixed determinations, such as when household members applied for and/or had eligibility determinations made for the two programs (i.e., parents were eligible for Covered California and the child(ren) were eligible for Medi-Cal). Covered California and Medi-Cal eligibility appeals are processed and adjudicated by Administrative Law Judges and the California Department of Social Services (CDSS) staff who track appeals and hearing results. This dataset is part of the public reporting requirements set forth in California Welfare and Institutions Code 14102.5(a)(6).

This dataset includes the number of individuals included on applications and the number of applications received for Insurance Affordability Programs (IAPs) from the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) by reporting period. Applications reported include applications submitted directly to CalHEERS, to Covered California, and to County Human Services Agencies through the Statewide Automated Welfare System (SAWS) eHIT interface. This dataset is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.

The number of Insurance Affordability Programs (IAPs) applications received through other eligibility pathways. Other eligibility pathways include applications transferred through transition from Advanced Premium Tax Credits (APTC) to Medi-Cal, as well as applications submitted through Hospital Presumptive Eligibility (HPE), through Express Lane, or the Medi-Cal Access Program (MCAP) during a reporting period. APTC to Medi-Cal batch data is reported by CalHEERS and MEDS and consists of individuals who are no longer eligible for APTC but are eligible for Medi-Cal. Another eligibility pathway is Express Lane Eligibility (ELE), which is a program that waives the need for a Medi-Cal eligibility determination for 12 months if the individual is enrolled in CalFresh. Hospital Presumptive Eligibility (HPE) applications are submitted through qualified HPE Providers. ELE and HPE data are reported by DHCS and commencing with this report, MCAP applications are reported by MAXIMUS Inc. This dataset is part of public reporting requirements of set forth in the California Welfare and Institutions Code 14102.5.

This dataset includes the number of newly eligible individuals enrolled in a Medi-Cal Managed Care Health Plans by type of enrollment by reporting period. Medi-Cal Managed Care program contracts for health care services through established networks of organized systems of care emphasizing primary and preventive care. Newly eligible Medi-Cal beneficiaries must choose a Managed Care health plan within 30 days of Medi-Cal enrollment, or they will be enrolled in a Managed Care health plan by default. This dataset is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.

This dataset includes age and gender of applicants for Insurance Affordability Programs (IAPs) during a reporting period. The age and gender data is from the California Healthcare Eligibility, Enrollment and Retention System (CalHEERS) and includes data from applications submitted directly to CalHEERS, to Covered California, and to County Human Services Agencies through the Statewide Automated Welfare System (SAWS) eHIT interface by reporting period. This dataset is part of public reporting requirements set forth by the California Welfare and Institutions Code 14102.5.