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From Health Affairs:


Medicaid/Marketplace "Churning": State-By-State Comparisons


Bethesda, MD -- The Affordable Care Act (ACA) requires almost all Americans to have health insurance. For most lower-income Americans, this means coverage through Medicaid, employer-sponsored insurance, or health exchanges, depending on their income and state of residence. Approximately half of all low-income, non-elderly Americans experience a change of income or family circumstance in a given year, which may result in an involuntary shift in how they are covered from health insurance purchased through an exchange to Medicaid--or vice versa. This process, called "churning," could lead to both gaps in coverage and disruptions in the continuity of care. A new study, being released today as a Web First by Health Affairs, provides state-by-state estimates of churning. Using data from two Census Bureau sources--its 2008 Survey of Income and Program Participation, and American Community Surveys from 2009-2011--the authors found that every state is likely to have significant numbers of residents whose eligibility changes over time: at least 40 percent of eligible adults over the course of twelve months. They observed that higher-income states and states with more generous Medicaid eligibility criteria in place before the ACA's expansion experienced a higher rate of churning, although differences between states were small. (The authors' analysis assumes that all states had expanded Medicaid under health reform. At the moment, twenty-five states and the District of Columbia have done so.)


Medicaid And Marketplace Eligibility Changes Will Occur Often In All States; Policy Options Can Ease Impact


By Benjamin D. Sommers, John A. Graves, Katherine Swartz, and Sara Rosenbaum


Sommers and Swartz are affiliated with Harvard School of Public Health in Boston; Graves is with Vanderbilt University in Nashville; and Rosenbaum is affiliated with The George Washington University in Washington, DC.


The study, which was funded by the Agency for Healthcare Research and Quality, will also appear in the April issue of Health Affairs.


The authors describe various available policy options to mitigate the effects of churning: new ways to demonstrate Medicaid eligibility, such as twelve-month continuous eligibility periods, or projecting annual income instead of monthly income filings. "The transition issues raised here will require attention in the coming years, and our key conclusion is that every state will need to address them," concluded the authors. "Reducing such churning will greatly increase the likelihood of stable coverage and improved quality of care under the Affordable Care Act."

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.