Mitigating the Effects of Churning Under the Affordable Care Act: Lessons from Medicaid

Rosenbaum, Sara; Lopez, Nancy; Dorley, Mark; Teitelbaum, Joel B.; Burke, Taylor A.; Miller, Jacqueline

doi:10.15868/socialsector.25001

Cited by 4 publications

(1 citation statement)

References 4 publications

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“…The growing disconnect between Medicaid administrative enrollment and survey-reported coverage suggest a missed opportunity to promote continuity of care during the pandemic, as some beneficiaries appeared not to understand that their Medicaid coverage had remained in place for more than 2 years without requiring an eligibility redetermination. Given research evidence that changes in coverage-so-called "churning"-has numerous negative financial and health-related effects, 27,28 future policy efforts to promote continuous coverage need to be clearly communicated to patients. For instance, starting in 2024, all states are required under federal law to provide 12 months of continuous coverage to children enrolled in Medicaid and the Children's Health Insurance…”

Section: Discussionmentioning

confidence: 99%

Survey-Reported Coverage in 2019-2022 and Implications for Unwinding Medicaid Continuous Eligibility

McIntyre,

Smith,

Sommers

2024

JAMA Health Forum

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ImportancePolicy changes and the COVID-19 pandemic affected health coverage rates, and the “unwinding” of Medicaid’s continuous coverage provision in 2023 and 2024 may cause widespread coverage loss. Recent coverage patterns in national survey and administrative data can inform these issues.ObjectiveTo assess national and state changes in survey-based Medicaid, private insurance, and uninsured rates between 2019 and 2022, as well as how these changes compare with administrative Medicaid enrollment totals.Design, Setting, and ParticipantsThis cross-sectional study analyzes nationally representative survey data for all US residents in the American Community Survey (ACS) from 2019 to 2022 compared with administrative data on Medicaid and the Children’s Health Insurance Program from the Centers for Medicare &amp; Medicaid Services (CMS). Data analysis was conducted between June 2023 and January 2024.ExposuresThe COVID-19 pandemic, the Medicaid continuous coverage provision, and policy efforts to increase Marketplace coverage.Main Outcomes and MeasuresMedicaid coverage (self-reported [ACS] and administratively recorded [CMS]), survey-reported uninsured, Medicare, and private insurance status.ResultsA nationally representative sample consisted of 12 506 584 US residents of all ages (survey-weighted 59.7% aged 19-64 years and 50.6% female). CMS statistics showed an increase in Medicaid coverage of 5.2 percentage points as a share of the population from 2019 to 2022. However, changes in the uninsured rate and survey-reported Medicaid were smaller: −1.2 (95% CI, −1.3 to −1.2) percentage points and 1.3 (95% CI, 1.2-1.4) percentage points, respectively. There was a 3.9 percentage point increase in the ACS’s “undercount” of Medicaid enrollment, compared with CMS data, from 2019 to 2022. This undercount was larger among children than adults but smaller in states that recently expanded Medicaid. Rates of additional forms of coverage (such as private insurance) among those in Medicaid also grew during this time.Conclusion and RelevanceIn this cross-sectional study, the uninsured rate declined considerably from 2019 to 2022 but was just one-fourth as large as the growth in administrative Medicaid enrollment under the pandemic continuous coverage provision. Survey-based Medicaid growth was far smaller than administrative growth. This suggests that many people who remained enrolled in Medicaid during the pandemic did not realize that their coverage had continued. These findings have implications for projecting uninsured changes during unwinding, as well as the effect of continuous coverage policies on continuity of care.

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Section: Discussionmentioning

confidence: 99%

Survey-Reported Coverage in 2019-2022 and Implications for Unwinding Medicaid Continuous Eligibility

McIntyre,

Smith,

Sommers

2024

JAMA Health Forum

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Does Churning in Medicaid Affect Health Care Use?

Roberts

Pollack²

2016

Medical Care

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Background Transitions into and out of Medicaid, termed churning, may disrupt access to and continuity of care. Low-income, working adults who became eligible for Medicaid under the Affordable Care Act are particularly susceptible to income and employment changes that lead to churning. Objective To compare health care use among adults who do and do not churn into and out of Medicaid. Data Longitudinal data from 6 panels of the Medical Expenditure Panel Survey. Methods We used differences-in-differences regression to compare health care use when adults reenrolled in Medicaid following a loss of coverage, to utilization in a control group of continuously enrolled adults. Outcome Measures Emergency department (ED) visits, ED visits resulting in an inpatient admission, and visits to office-based providers. Results During the study period, 264 adults churned into and out of Medicaid and 627 had continuous coverage. Churning adults had an average of approximately 0.05 Medicaid-covered office-based visits per month 4 months before reenrolling in Medicaid, significantly below the rate of approximately 0.20 visits in the control group. Visits to office-based providers did not reach the control group rate until several months after churning adults had resumed Medicaid coverage. Our comparisons found no evidence of significantly elevated ED and inpatient admission rates in the churning group following reenrollment. Conclusions Adults who lose Medicaid tend to defer their use of office-based care to periods when they are insured. Although this suggests that enrollment disruptions lead to suboptimal timing of care, we do not find evidence that adults reenroll in Medicaid with elevated acute care needs.

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Key Provisions of the Patient Protection and Affordable Care Act (ACA): A Systematic Review and Presentation of Early Research Findings

French

Homer

Gümüş

et al. 2016

Health Services Research

135

119

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Mitigating the Effects of Churning Under the Affordable Care Act: Lessons from Medicaid

Cited by 4 publications

References 4 publications

Survey-Reported Coverage in 2019-2022 and Implications for Unwinding Medicaid Continuous Eligibility

Survey-Reported Coverage in 2019-2022 and Implications for Unwinding Medicaid Continuous Eligibility

Does Churning in Medicaid Affect Health Care Use?

Key Provisions of the Patient Protection and Affordable Care Act (ACA): A Systematic Review and Presentation of Early Research Findings

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