Problem of Churn and Providing Continuity of Care
In 2014, Medicaid coverage will be extended to all nonelderly citizens whose family income does not exceed 133 percent of the federal poverty level, while subsidized coverage will be offered to those who are not eligible for Medicaid and there is income up to 400 percent of the federal poverty level. Income changes could lead to the "churning" of millions of adults and their families between Medicaid and the state exchanges. It is projected that within a six-month timeframe more than 35 percent of all adults with family incomes below 200 percent of FPL will experience a shift in eligibility from Medicaid to Subsidized coverage. Within a year, an estimated 28 million individuals will transition from coverage through an exchange to Medicaid.
The biggest challenge states will face is providing continuous coverage for a complete year. Seamless coverage from program to program will help minimizing interruptions in care and will promote high-quality and consistent services for people. If the coverage transitions are strategically designed then it can help continuity of care.
While establishing the exchange States are developing strategies to address the churning. Like state of Massachusetts, has extensive contract language. This language guide MCO coverage transitions between Medicaid and the state's Health Connector program. State of Tennessee has proposed a policy that will allow families to have common carrier or provider network for Medicaid and Subsidized coverage. States are also considering various options for limiting churning and providing continuity of coverage like limiting enrollment or eligibility changes in given year, aligning coverage and benefits between Medicaid and the insurance exchanges, offering same policies to both Medicaid and exchange-subsidized individuals.
ACA mandates States to provide health insurance to increasing number of individuals but it cannot avoid movement of people from one insurance program to other. Anticipating the large number of transition between insurance programs state needs to provide a strategic solution which is capable of managing smooth and seamless transitions between different programs.