Study: Medicaid churn declined in expansion states

Medicaid
A new study examines Medicaid churn following the Affordable Care Act's expansion. (Getty/designer491)

Medicaid enrollment churn eased following the rollout of the Affordable Care Act (ACA), a new study shows. 

Research published in the January issue of Health Affairs found that both Medicaid coverage disruptions and coverage loss declined by 4.3% in states that expanded the program under the ACA. 

Men, people of color and people without chronic conditions saw some of the greatest improvements, according to the study. About 20% of men in expansion states, for example, experienced disruption in coverage before the ACA was in place, a rate that declined to 14.9% after the rollout of the law. 

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RELATED: Medicaid, CHIP enrollment decline for 2nd straight year 

Anna Goldman, M.D., assistant professor of medicine at Boston University School of Medicine and the study’s lead author, told FierceHealthcare that the impact of the landmark healthcare law on the stability of coverage is an underexamined area. 

“The big headline about the ACA was increasing insurance coverage,” Goldman said, “but the stability of coverage is a secondary issue that matters a lot to patients and should to policymakers.” 

Coverage gaps can pose significant access challenges, she said, as people between plans do at times report delays in preventive or emergency care. This is especially true for lower-income people who would qualify for Medicaid. 

Medicaid is a program with a significant amount of churn, Goldman said, a trend that fluctuates state by state based on how it’s designed. 

“It’s not easy to stay in Medicaid,” she said. 

RELATED: Medicaid expansion linked to decline in preventable hospitalizations, study finds 

The study found that men living in expansion states saw their rate of coverage loss decline from 16% before the ACA to 10% under the ACA. For people of color, coverage disruption rates declined from 17.9% to 13.4%, and coverage loss rates decreased from 14.8% to 10.7%. 

In addition, for people without chronic illnesses, coverage disruption rates decreased from 20.7% to 15.4% after the expansion went into effect, and coverage loss rates went down from 17.9% to 11.7%, according to the study. 

Goldman said a key theme from the findings is that making coverage easier for people to understand and easier for them to maintain pays off. 

“I think a big takeaway is that simplifying rules is good, important and helps people,” she said. 

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