Veterans of the Medi-Cal system in California — providers, counselors, state officials and beneficiaries — have said for years that one of the keys to making the Medicaid program work is continuity of care. But in most lives –and perhaps especially in low-income lives — things change. People move, they change or lose jobs, their family situations evolve. When change happens, eligibility for subsidized coverage shifts and health care is often interrupted.
Health care officials who work with large Medi-Cal populations say fluctuations in eligibility cause quality of care to decline and the cost of care to increase because of added administrative expenses. Medi-Cal beneficiaries moving in and out of coverage — known as “churning” — is not a new phenomenon, but it may become more prevalent under health care reform.
The Affordable Care Act’s two primary weapons aimed at reducing the number of uninsured — expanded Medicaid eligibility and subsidies for buying private coverage through state health insurance exchanges — could produce considerable churning if they’re not carefully implemented.
According to a study published last month in Health Affairs, income fluctuations in the first year of expanded coverage under the new law could produce eligibility shifts for as many as 28 million people who will become newly eligible for subsidized health insurance. According to researchers’ predictions, after four years of expanded coverage under ACA, 19% of adults initially eligible for Medicaid will have been continuously eligible. About 31% of adults eligible for insurance subsidies will have remained continuously eligible, researchers predict.
In California, nearly five million uninsured Californians will gain access to health insurance in 2014. State officials and the board of the newly formed health benefits exchange are working on constructing a system to get ready for them as well as the millions of low-and middle-income Californians who will be eligible to participate in the exchange.
We asked stakeholders and experts: What strategies should state officials employ in the building and operation of the exchange to minimize churning and promote quality and continuity of care?
We got responses from: