With the Affordable Care Act providing broader access to insurance, states and insurers are both working to prevent new health plan members from coverage disruptions when they transition between different plan types.
Although the ACA actually reduces churning by making health plans more accessible and affordable, it's also created more options for consumers to move between plans, reported The Health Care Blog. That means about 9 million people will likely fluctuate between Medicaid and the plans sold on the health insurance exchanges this year, making churning a major challenge in every state, FierceHealthPayer previously reported.
To help reduce this churning, states and insurers can take three key steps. However, the best strategy for each state depends on local factors, including Medicaid eligibility levels, preexisting Medicaid waivers from the federal government, Medicaid expansion status and managed care within Medicaid systems, the blog post noted.
1. Ensure continuity of care: States with regulatory oversight can require that insurers operating Medicaid plans guarantee continuity of care to their members. For example, Medicaid insurers in Maryland and Rhode Island must continue paying for certain courses of treatment, so a patient in the middle of chemotherapy treatment can still receive care from their doctor if they churn into different coverage.
2. Build a bridge between Medicaid and private coverage: Another key to reduce churning is to take advantage of exchanges. States like Nevada and California require Medicaid insurers to sell plans on the marketplace so that consumers undergoing a change in Medicaid eligibility can stay with the same insurance company.
3. Allow "wraparound subsidies:" To help consumers afford the new plans they're churning into, especially if they have higher premiums and cost-sharing requirements, states can allow "wraparound subsidies." This would lower out-of-pocket costs for low-income consumers in exchange plans. Massachusetts, for example, is considering implementing wraparound subsidies for certain consumers.
To learn more:
- read the The Health Care Blog article