California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS)

Introduction:

The Affordable Care Act of 2010, known as federal health care reform, requires states to establish Health Benefit Exchanges for individuals and small businesses to obtain affordable health care coverage. The California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) is an automated system that:

Serves as the consolidated system support for eligibility, enrollment, and retention for the California Health Benefit Exchange (also known as Covered California), Medi-Cal, and Healthy Families.

Streamlines resources from which individuals and small businesses will be able to research, compare, check their eligibility for, and purchase health coverage.

The CalHEERS Project began in June 2012, with the system going live to the public 15 months later on October 1, 2013. The CalHEERS system development involved the two project sponsors - Covered California and Department of Healthcare Services (DHCS) - and 13 program partners. CalHEERS supports the maintenance, operations, and on-going business of Covered California. It is also one of the systems that support the maintenance, operations, and on-going business of the DHCS. CalHEERS supports account creation, consumer application, eligibility rules, and health plan selection for insurance affordability programs. CalHEERS interfaces via the Electronic Health Information Transfer (eHIT) with the Statewide Automated Welfare Systems (SAWS) for Modified Adjusted Gross Income (MAGI) Medi-Cal eligibility, enrollment and reporting, and provide data for potential eligibility to other programs such as, non-MAGI Medi-Cal, CalFresh, and California Work Opportunities and Responsibility for Kids (CalWORKS).

The CalHEERS Project is currently transitioning to an Operations and Maintenance organization.