Covered California Launches Population Health Investments Initiative

Covered California, the state’s health insurance marketplace, has launched an initiative that will reinvest millions of dollars collected from underperforming health plans back into its enrollees through programs designed to benefit their wellness.

The Population Health Investments (PopHI) program will use funds that Covered California has recouped through a health-plan accountability program. As a California Health Care Foundation report noted, the available money — which totaled about $15 million in 2024 — is “the byproduct of Covered California’s new Quality Transformation Initiative (QTI). It requires insurers selling health plans on the exchange to meet minimum quality and equity benchmarks for high blood pressure and diabetes treatment, colorectal cancer screenings, and children’s vaccinations. Plans that fall short of the benchmarks must pay financial penalties to Covered California. These increase over time if the plans continue to underperform.”

One PopHI program, which is known to enrollees as the Beyond Covered by Covered California Grocery Support Program, is designed to help enrollees with chronic health conditions and financial challenges access nutritious food to improve food security and health outcomes. The other PopHI program, the Child Savings Account Program, aims to improve well-child visits and childhood immunization rates for children under two while helping families invest in their child’s future.

Covered California’s third investment is aimed at leveraging the Equity and Practice Transformation infrastructure, developed by the Department of Health Care Services to accelerate population-health management capabilities in primary care practices serving both Covered California and Medi-Cal enrollees. The investments will fund subject-matter expert support, virtual learnings, peer engagement, advanced data integration and testing, as well as the development of a learning system to distill insights and models to primary care practices across the state.

For this program, over 45 practices will receive enhanced support through tailored enhancements to the Equity and Practice Transformation’s technical assistance structure.

“We are delighted to make these investments a reality,” said Monica Soni, M.D., Covered California’s chief medical officer and leader of the program’s implementation team. “This is about holding health plans accountable for high-quality care, while also reinvesting in the health and wellness of Californians.”

Covered California members with a household income up to 250 percent of the federal poverty level who have a chronic health issue and are experiencing food insecurity will be eligible for the Grocery Support Program, in which they receive a reloadable debit card to purchase food.
Funds will be based on household size reported at the time of enrollment and may only be used to purchase fresh food, packaged food, baby food and non-alcoholic drinks.

Covered California enrollees with children under the age of two who are born in California and registered for a CalKIDS account can earn up to $1,000 for their child’s savings account, which can be used for future higher educational expenses under the Child Savings Account program.

Payments are tied to the completion of well-child visits and receipt of vaccines according to clinical guidelines.

“We wanted to address the concerns raised by our members when choosing how to make the investments,” said Covered California Executive Director Jessica Altman in a statement. “Together, the programs aim to improve immediate health outcomes, but also foster long-term financial security, because our commitment is to reducing health disparities and enhancing the quality of life for all our members.”

Covered California said these investments represent its commitment to evidence-based interventions developed in collaboration with consumer advocates, health insurance companies, the Department of Health Care Services, CalPERS, and an advisory council composed of key stakeholders and subject matter experts, including a current Covered California enrollee.

All of the programs will run through March 2026. The Grocery Support Program will then be evaluated by the Social Interventions Research and Evaluation Network (SIREN) from the University of California San Francisco. The Child Savings Account Program will be assessed by Drs. Adam Schickedanz and Monique Holguin, co-directors of the University of California Los Angeles Medical-Financial Partnership.