ACA Will Bring Frequent Medicaid, Insurance Eligibility Changes

Low- and middle-income adults will likely experience frequent changes in eligibility for Medicaid and health insurance exchange coverage under the Affordable Care Act (ACA), according to a new study.

Benjamin D. Sommers, an assistant professor of health policy and economics at the Harvard School of Public Health, and colleagues found that depending on income and state of residency, most lower-income Americans could experience “churning” leading to gaps in coverage and disruptions in the continuity of care.

The researchers used data from the Census Bureau’s 2008 Survey of Income and Program Participation, and the bureau’s American Community Surveys from 2009-2011. The study, published online in the March 2014 issue of Health Affairs, reported that in every state there will be a significant number of residents with changing eligibility.

“Even in states with the least churning, we estimated that more than 40 percent of adults likely to enroll in Medicaid or subsidized Marketplace coverage would experience a change in eligibility within twelve months,” the investigators wrote.

Sommers and his colleagues provided state-by-state estimates of potential eligibility changes if all states expanded Medicaid and identified predictors of rates of churning within states. And while frequent eligibility changes will occur in all 50 states, higher-income states and states with more generous Medicaid eligibility criteria in place before the ACA will experience more churning. However, the researchers noted that differences were small.

There are possible ways to reduce the frequency, though, and the authors suggested several policy options. States can adopt 12-month continuous eligibility for adults in Medicaid, create a Basic Health Program, use Medicaid funds to subsidize coverage for low-income adults, and encourage insurers offer plans in Medicaid and the marketplaces.

“The transition issues raised here will require attention in the coming years, and our key conclusion is that every state will need to address them,” the researchers concluded. “Reducing such churning will greatly increase the likelihood of stable coverage and improved quality of care under the Affordable Care Act.”