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. 2015 Jul;34(7):1180-7.
doi: 10.1377/hlthaff.2014.1204.

Reducing Medicaid Churning: Extending Eligibility For Twelve Months Or To End Of Calendar Year Is Most Effective

Katherine Swartz  1 , Pamela Farley Short  2 , Deborah Roempke Graefe  3 , Namrata Uberoi  4
Affiliations

Reducing Medicaid Churning: Extending Eligibility For Twelve Months Or To End Of Calendar Year Is Most Effective

Katherine Swartz et al. Health Aff (Millwood). 2015 Jul.

Abstract

Medicaid churning--the constant exit and reentry of beneficiaries as their eligibility changes--has long been a problem for both Medicaid administrators and recipients. Churning will continue under the Affordable Care Act because, despite new federal rules, Medicaid eligibility will continue to be based on current monthly income. We developed a longitudinal simulation model to evaluate four policy options for modifying or extending Medicaid eligibility to reduce churning. The simulations suggest that two options--extending eligibility either to the end of a calendar year or for twelve months after enrollment--would be the most effective methods for reducing churning. The other options--a three-month extension or eligibility based on projected annual income--would reduce churning to a lesser extent. States should consider implementation of the option that best balances costs while improving access to coverage and, thereby, the health of Medicaid enrollees.

Keywords: Health Reform; Medicaid.

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Figures

Exhibit 2
Exhibit 2
Four Policy Options’ Estimated Effects on Percentage Change in Adults with Medicaid Churning, with Three Alternative Pairs of Simulation Assumptions Source: Authors’ simulation model using 2004–2007 Panel of the Survey of Income and Program Participation. Notes: High Participation and Low Participation are assumed Medicaid participation rates of 85% and 50%, respectively. High Disruption and Low Disruption are assumed administrative disruption rates of 35% and 15%, respectively.
Exhibit 3
Exhibit 3
Four Policy Options’ Estimated Effects on Percentage Change in Adults Covered All Year by Medicaid, with Three Alternative Pairs of Simulation Assumptions Source: Authors’ simulations using 2004–2007 Panel of the Survey of Income and Program Participation. Notes: High Participation and Low Participation are assumed Medicaid participation rates of 85% and 50%, respectively. High Disruption and Low Disruption are assumed administrative disruption rates of 35% and 15%, respectively.
Exhibit 4
Exhibit 4
Four Policy Options’ Estimated Effects on Percent Change in Average Monthly Medicaid Caseload, with Three Alternative Pairs of Simulation Assumptions Source: Authors’ simulations using 2004–2007 Panel of the Survey of Income and Program Participation. Notes: High Participation and Low Participation are assumed Medicaid participation rates of 85% and 50%, respectively. High Disruption and Low Disruption are assumed administrative disruption rates of 35% and 15%, respectively.
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References

Endnotes

    1. Sommers BD. From Medicaid to uninsured: drop-out among children in public insurance programs. Health Serv Res. 2005;40(1):59–78. - PMC - PubMed
    1. Sommers BD. Why millions of children eligible for Medicaid and SCHIP are uninsured: poor retention versus poor take-Up. Health Aff (Millwood) 2007;26(5):w560–7. - PubMed
    1. Fairbrother G, Dutton MJ, Bachrach D, Newall KA, Boozang P, Cooper R. Costs of enrolling children in Medicaid and SCHIP. Health Aff (Millwood) 2004;23(1):237–243. - PubMed
    1. Hill I, Lutzky AW. Understanding SCHIP Retention. Washington (DC): Urban Institute; 2003. Is there a hole in the bucket?
    1. Perry M, Kannel S, Riley T, Pernice C. What parents say: why eligible children lose SCHIP. Portland (ME): National Academy for State Health Policy; 2001.

References for Appendix

    1. Kaiser Commission on Medicaid and the Uninsured. Holding Steady, Looking Ahead: Annual Findings of a 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and CHIP, 2010–2011. 2011 Publication #8130, Jan. Available at: http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8130.pdf.
    1. Sommers BD, Swartz K, Epstein AM. Policy Makers Should Prepare for Major Uncertainties in Medicaid Enrollment, Costs, and Needs for Physicians Under Health Reform. Health Affairs. 2011;30(11):2186–93. - PubMed
    1. Elmendorf DW. Testimony Statement of Douglas W. Elmendorf, Director. Congressional Budget Office, before the Subcommittee on Health, Committee on Energy and Commerce, U.S. House of Representatives, “CBO’s Analysis of the Major Health Care Legislation Enacted in March 2010. 2011 Mar 30; Available at: http://www.cbo.gov/sites/default/files/03-30-healthcarelegislation.pdf.
    1. Kaiser Family Foundation. Medicaid Coverage and Spending in Health Reform: National and State by State Results for Adults At or Below 133% FPL. 2010 May; Available at: http://www.kff.org/healthreform/upload/Medicaid-Coverage-and-Spending-in....
    1. Sommers BD, Epstein AM. Medicaid Expansion – the Soft Underbelly of Health Care Reform? New England Journal of Medicine. 2010;363(22):2085–7. - PubMed

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