The reintroduction of the bipartisan “Stabilize Medicaid and CHIP Coverage Act of 2017” in the House (Green, D-Texas, and Barton, R-Texas) and the Senate (Brown, D-Ohio) provides 12 months of continuous eligibility to Medicaid and Children’s Health Insurance Program (CHIP) enrollees, mitigating the effect of what is known as “churn” for enrollees and health plans. “Churn” affects millions of enrollees who are disenrolled from Medicaid or CHIP due to changes in income or paperwork, despite being otherwise eligible.
“Representatives Green and Barton and Senator Brown have shown strong and unwavering leadership on the issue of churn in Medicaid, and for that ACAP and its member Safety Net Health Plans are grateful,” said Association for Community Affiliated Plans (ACAP) Chief Executive Officer (CEO) Margaret A. Murray. “This is a common-sense, bipartisan solution which strengthens the Medicaid and CHIP programs to assure beneficiaries coverage they can count on through 12 months of continuous enrollment.”
A 2015 paper produced by the Milken School of Public Health for ACAP noted if patients lose insurance coverage for even a few months, their medical care, access to prescription medications, and other therapies can be interrupted. Some of the problems found when enrollment continuity was compromised include: greater use of emergency rooms, higher hospitalizations for conditions that can be mediated by effective primary care (e.g., asthma or diabetes), and higher rates of serious mental health problems leading to hospitalization. More recent research has continued to find gaps in coverage are associated with delays in screening, detection, and treatment of cancer, which may result in higher mortality.
John Lovelace, President of UPMC for You and ACAP Chair, noted, “Twelve-month continuous enrollment means that health plans would be able to spend less time on-boarding new members and more time coordinating care. It means that staff in provider offices isn’t diverted to eligibility verification and re-verification – they can spend more time helping patients.”
Leanne Berge, the new CEO of Community Health Plan of Washington, added its plan “is committed to ensuring every new Medicaid enrollee has access to a primary care provider and high quality, consistent care. We want to keep our members in our plan as long as they are eligible, because the more consistent the coverage, the better the health outcomes and overall health status.”
Medicaid continuity gaps harm quality and are inefficient. Analyses of the 2012 Medical Expenditure Panel Survey (MEPS) reveal monthly Medicaid costs are lower when people are enrolled longer. An 18- to 64-year-old adult enrolled for a full 12 months has estimated average monthly Medicaid costs of $326 per month, while someone enrolled for only one month incurs $705 in Medicaid expenditures per month, and someone enrolled for six months of the year has a monthly cost of $512.
As important as it is for health plans to raise this issue, there is language in both the House and Senate versions of the repeal/replace legislation (the American Health Care Act in the House, and the Better Care Reconciliation Act in the Senate) stating “the state plan may provide that the individual’s eligibility shall be redetermined every six months (or such shorter number of months as the state may elect).” By allowing states shorter options, this provision could potentially increase efficiencies for health plans. Plans owe it to press their members of Congress on the importance of 12-month eligibility for health plans’ ability to control costs.
Want to stay up to date on policy and regulation changes? The Insider is GHG’s exclusive intelligence briefing, providing in-depth analysis and expert summaries of the most critical legislative and political activities impacting and shaping your organization. Read our full press release >>
Stay connected to industry news and gain perspective on how to navigate the latest issues through GHG’s weekly newsletter. Subscribe >>