Too many Medicaid clients 'churn' in and out of the program
Too many Medicaid clients 'churn' in and out of the program
Medicaid enrollees often face gaps in insurance coverage, even though they remain eligible for the program, causing them to "churn" in and out of the program. This interrupts the continuity of medical care, which can lead to harmful health consequences, according to a new report, Improving Medicaid's Continuity and Quality of Care, written by researchers at The George Washington University and sponsored by the Association for Community Affiliated Plans (ACAP), both based in Washington, DC.
Each year, millions of people enroll in Medicaid, only to lose their coverage subsequently. This occursdespite their continued eligibility because of inefficient and cumbersome paperwork requirements.
The typical enrollee receives Medicaid coverage for about three-quarters (78%) of the year, according to the researchers. They note that this loss of coverage among Medicaid enrollees contributes to the number of uninsured and has negative consequences for individuals, providers, states, and health plans.
Unstable coverage can impede access to health care services and lead to poorer health outcomes for individuals, the researchers say.
In addition to its negative effects on clinical health care of patients, "churning" increases administrative costs for both state Medicaid agencies and their contractors. "States are reviewing options, opportunities and limitations of current laws to determine the strategies to most efficiently and effectively address operational policies and procedures that relate to churning," says Patricia MacTaggart, a lead research scientist and lecturer at the department of health policy at the George Washington University.
Changing enrollment harmful
Some of the negative effects of churning, says Ms. MacTaggart, are loss of continuity of care, poorer access to care, missed preventive care, and individuals returning to the Medicaid program when they are in need of medical care at a more expensive and serious state of illness.
Churning also interferes with quality measurement, since accountability measures, such as those in The Healthcare Effectiveness Data and Information Set (HEDIS), require continuous enrollment. For this reason, quality monitoring and improvement efforts by providers, including managed care organizations and state and federal governments, are impaired by gaps in coverage.
"Since some Medicaid enrollees are not enrolled long enough to be assessed for quality due to churning, the ability for the state to validate the quality of the health care received by some of the Medicaid population is diminished," says Ms. MacTaggart.
To reduce the problem of churning, most states are reviewing the additional opportunities provided through the Children's Health Improvement Program Reauthorization Act to further simplify administrative processes. The goal, says Ms. MacTaggart, is to "more efficiently enroll children, in order to provide children the right care at the right time from the right providers, through continuity of care and continuity of coverage."
According to Leighton Ku, PhD, MPH, the report's lead author and a professor in the department of health policy at The George Washington University School of Public Health and Health Services, over the years, state Medicaid and CHIP programs have worked with community leaders and advocates to improve and simplify enrollment and retention efforts, especially for children.
"We want to help them continue these efforts to transform Medicaid from a welfare-based program that is often trying to disqualify people, to a program that seeks to bring cost-effective health coverage and security for low-income families and individuals," says Dr. Ku. "This would also make a valuable contribution to national efforts to reform health care and reduce the number of uninsured Americans."
Continuous eligibility
As ACAP and its member health plans dug into the two issues of continuous eligibility and quality, "it became very clear that they should be dealt with in tandem," says Jennifer McGuigan Babcock, ACAP's director of policy.
In terms of continuous eligibility, safety-net health plans think disruptions in care are dangerous, because they increase the likelihood that their health status will be negatively affected, she says.
Over years of serving Medicaid and other public coverage programs, safety net health plans have developed "core competencies" of intensive patient engagement and effective care coordination for people with complex needs, she says. This ensures good access to care.
"This coordination is disrupted when people lose their Medicaid coverage and no longer have a connection to their health plans. There is an obvious quality impact," says Ms. Babcock. "It is important to consider these issues within the framework of health care reform."
The report proposes the Medicaid Continuous Quality Act, which would establish 12-month continuous eligibility for all Medicaid populations. States would receive incentives for adopting continuous eligibility policies, and all models of care would utilize the same quality monitoring procedures.
Ms. Babcock notes that certain themes have emerged during the ongoing health care reform debate, suggesting the direction that Congress and the White House will take with reform.
"Several of the most critical of these are well aligned with our goals related to continuous eligibility and quality," she says.
For example, universal and continuous coverage is one important health reform goal. "We believe that if Medicaid enrollees frequently lose their health coverage, we as a nation are not fully addressing the problem of uninsurance among low-income people," says Ms. Babcock. "Another example is the expansion of Medicaid to higher income levels, some version of which is included in all of the significant reform proposals."
ACAP fully supports this expansion, says Ms. Babcock, "but without safeguards against people losing their Medicaid coverage, this goal of covering more people with the program also will not be fully accomplished."
Contact Ms. Babcock at (202) 204-7510 or [email protected], Dr. Ku at (202) 994-4143 or [email protected], and Ms. MacTaggart at (202) 994-4227 or [email protected].
Medicaid enrollees often face gaps in insurance coverage, even though they remain eligible for the program, causing them to "churn" in and out of the program.Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.