Consumer, Payer Groups Ask Congress to Address Medicaid Churn
The significant amount of churn in Medicaid and Children’s Health Insurance Program (CHIP) insurance coverage is often caused by inefficient paperwork, overly burdensome reporting requirements, or temporary income fluctuations. Five states already provide 12-month continuous eligibility to all or some adults, and other states are pursuing policies to ensure eligible enrollees retain their coverage.
Now a group of almost 190 organizations representing healthcare consumers, payers and providers has sent a joint letter to Congressional and committee leadership urging them to support 12-month continuous eligibility for adults enrolled in Medicaid and CHIP.
The joint letter calls on Congress to enact the Stabilize Medicaid and CHIP Coverage Act, H.R. 5434 and S. 3138.
Medicaid and CHIP provide critical health coverage to more than 80 million Americans, including children, pregnant people, people with disabilities, older adults and adults with low incomes. Millions of enrollees lose this safety net coverage within a year – despite often still being eligible – only to re-enroll within a few months.
Evidence abounds of the benefits of continuous eligibility in Medicaid and CHIP, including improved health outcomes, lower avoidable administrative costs, and relief for providers from double-checking that their patients retain coverage, the organizations say.
“The staggering disenrollment rate during the Medicaid unwinding only increases the urgency to put in place strong state policies to keep people covered. Communities of color are especially vulnerable to fall through cracks in coverage," said Anthony Wright, Families USA Incoming Executive Director, in a statement. “Gaps in coverage can be the difference between life and death, as people caught in the churn have worse access to treatments, delay needed care and end up in the emergency department more often. Congress must pass the Stabilize Medicaid and CHIP Coverage Act and work to ensure more equitable access to stable, continuous coverage for our nation’s adults.”
“We are grateful for Congress’ work in passing nationwide 12-month continuous eligibility for all children in Medicaid and CHIP through the Consolidated Appropriations Act of 2023,” said Jennifer McGuigan Babcock, senior vice president for Medicaid policy at the Association for Community-Affiliated Plans (ACAP), in a statement. “We now ask that this protection be extended to adults. No one should fear losing their access to comprehensive health care due to missing paperwork or fluctuations in income due to working a few extra hours in a given month or by picking up an additional shift.”
ACAP represents 82 health plans, which collectively provide health coverage to more than 25 million people.
One example of a state-level effort is in Massachusetts, which will provide 12 months of continuous eligibility for adults and 24 months of continuous eligibility for members experiencing homelessness who are 65 and over. MassHealth has the authority to extend 12 months of continuous eligibility to all adults aged 19 and over. Continuous eligibility for children under age 19 began in January of 2024, so this amendment extends 12 months of continuous eligibility to all MassHealth members. Continuous eligibility means that members will retain coverage for the appointed period even if they experience changes in their circumstances that would otherwise affect eligibility. MassHealth will also extend 24 months of continuous eligibility for members experiencing homelessness age 65 and over.
Through a new benefit program called Oregon Health Plan (OHP) Bridge, an estimated 100,000 people are anticipated to eventually qualify for free health coverage.
Before the COVID-19 pandemic, many adults in Oregon with income just above traditional Medicaid limits were uninsured. Additionally, about 34% of members who lost benefits would return to Medicaid within a year due to fluctuating income. OHP Bridge is designed to help people keep their coverage and their same doctors despite short-term fluctuations in income.
