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Ensuring Continuous Coverage in Transition between Medicaid and Marketplaces



This week in Washington—ensuring continuous coverage for people transitioning between Medicaid and insurance offered through the exchanges. You are tuning in to the health policy update from America’s Essential Hospitals for the week of Aug. 26.

Throughout this series, we’ve talked about the types of plans that will be available to people through the health insurance exchanges that were created by the Affordable Care Act (ACA). Today, we talk about the people who will transition between these plans and Medicaid coverage.

As you know, people who meet certain eligibility requirements can receive coverage through Medicaid. If they earn more than the income eligibility requirements, though, they will no longer be able to receive that coverage. As a result, whether or not a person is eligible for Medicaid can change at any time depending on fluctuations in their income.

This is significant because many people who are enrolled in Medicaid work hourly jobs, so their incomes can fluctuate depending on the number of hours they work each week. As a result, even small changes in income may mean that people will shift between being eligible for Medicaid and subsidies to help purchase insurance coverage through the exchanges. In fact, one study published in Health Affairs estimated that within one year, 50 percent of adults with family incomes at or below 200 percent of the poverty level will have to transition from coverage offered through an exchange to Medicaid, or vice versa. This transition between Medicaid and insurance coverage offered through the exchanges is known as “churning.”

Churning can cause problems for continuity of coverage and care. Frequent coverage changes can be exhausting and confusing, especially for people with low incomes who are likely to experience other barriers to care like English language proficiency. Frequent coverage changes may also mean that people have to switch providers, which prevents them from seeing the same doctors and nurses they have gotten to know. These and other issues may prevent people from actually going through the hassle of continuing to enroll in coverage at all.

To avoid these kinds of problems, it will be important to minimize the number of times that people transition between Medicaid and insurance coverage offered through the exchanges. It will also be important to ensure that when people experience a transition, the services they need and the providers they choose are covered through their insurance plan.

Thanks for listening to another edition of This Week in Washington. I’m Erin Richardson; join us next week as we continue our discussion of health insurance exchanges.


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