Reducing Medicaid Churning: Extending Eligibility For Twelve Months Or To End Of Calendar Year Is Most Effective

Abstract

Medicaid churning - the constant exit and re-entry of beneficiaries as their eligibility changes - has long been a problem for both Medicaid administrators and recipients. Churning will continue under the Affordable Care Act, because despite new federal rules, Medicaid eligibility will continue to be based on current monthly income. We developed a longitudinal simulation model to evaluate four policy options for modifying or extending Medicaid eligibility to reduce churning. The simulations suggest that two options, extending Medicaid eligibility either to the end of a calendar year or for twelve months after enrollment, would be far more effective in reducing churning than the other options of a three-month extension or eligibility based on projected annual income. States should consider implementation of the option that best balances costs, including both administration and services, with improved health of Medicaid enrollees.

Comparative cost‐effectiveness of mailed fecal immunochemical testing (FIT)–based interventions for increasing colorectal cancer screening in the Medicaid population

“…In addition, Medicaid enrollment may be short-lived, with high rates of churning in some subpopulations. 42,43 Nevertheless, Medicaid enrollment was relatively continuous in our population aged 52 to 64 years; among the 2144 patients in the parent study who were identified as eligible and were randomized to receive 1 of the 2 reminder-based programs, only 4 reported not participating because of loss of Medicaid insurance, and none of the 18 FIT-positive patients reported losing Medicaid insurance by the time of followup navigation.…”

The high burden of alcoholic cirrhosis in privately insured persons in the United States

“…Though recently reversed, the Center for Medicare and Medicaid had previously eliminated all substance use disorder claims from their available data sets, thus limiting analysis of substance‐related medical disease like ALD in persons covered by Medicare or Medicaid . Many AC patients are Medicaid‐insured due to low income and socioeconomic status, and as many as 50% of them will lose eligibility yearly due to income fluctuations, making large‐scale national analyses of this population over time challenging . Even within our well‐characterized cohort, AC prevalence may be underestimated due to failure to recognize an alcohol etiology, which has been shown to occur in other studies where mortality from ALD was underestimated by 2‐fold due to patient concealment and stigma .…”

Preventive Care Use Among Justice-Involved and Non–Justice-Involved Youth

“…More and longer gaps in insurance coverage experienced by JIY is evidence of churning, or frequent movement between publicly insured, privately insured, and uninsured status. 23 Reasons for churning include changes in insurance eligibility (eg, increased income, incarceration), acquisition of insurance from another source, or dropout of eligible recipients (eg, failing to complete required reenrollment applications). Churning for Medicaid enrollees most often reflects dropout, meaning that individuals move from public insurance rolls to uninsured status, despite continued eligibility for coverage.…”

“…To address access to care, several states have expanded eligibility for Medicaid or auto-enrolled eligible patients, which should reduce churning and provide greater access to affordable care. 14,23 Efforts to improve access to primary care for individuals in the justice system have targeted offenders' release from secure confinement, enrolling prisoners in Medicaid or connecting them to a primary care physician as part of standard facility discharge planning. 32,33 Given the dramatic impact of continuous Medicaid coverage on preventive care utilization among JIY ( Fig 1B), and in light of previous calls to improve Medicaid coverage for individuals involved in the justice system, 32,33 policy change to increase Medicaid enrollment for JIY remains a priority.…”