Background
Medicaid provides health insurance coverage to nearly 60 million low-income children, parents, seniors and people with disabilities. Unfortunately, Medicaid enrollment is like a leaky sieve; every year millions of people enroll, only to subsequently lose their coverage, despite still being eligible, because of inefficient and cumbersome paperwork requirements. The interruptions in coverage affect the continuity and effectiveness of health care received.
A 2008 George Washington University (GWU) study commissioned by ACAP entitled “Improving Medicaid’s Continuity of Coverage and Quality of Care” found that the typical enrollee receives Medicaid coverage for about three-quarters of the year. Research has shown that even brief gaps in insurance coverage can have harmful consequences for people, because they have poorer access to care and to prescription drugs during the time they are uninsured and because it interrupts the continuity of medical care. Continuous Medicaid enrollment is more efficient, both medically and administratively. The GWU study also shows that longer periods of Medicaid enrollment lowers average monthly medical costs. The average monthly medical expenditure for an adult enrolled in Medicaid for 12 continuous months is about two-thirds the level of a person enrolled for just six months and half the level of a person enrolled for just one month. When people enroll, then dis-enroll, and then enroll again, they incur much higher administrative costs associated with enrollment procedures and processing for new enrollees.
This problem is likely to be exacerbated once the Affordable Care Act’s Medicaid expansion provisions take effect in 2014. Improving retention in Medicaid is a cost-effective way to reduce the number of uninsured people, strengthen the stability of their health insurance coverage, improve the measurement of health care quality, and ultimately improve people’s health.
ACAP Position and Legislative Action
ACAP is actively working with members of Congress and many interested partners to introduce legislation that would ease this problem by providing continuous eligibility to Medicaid beneficiaries. ACAP has developed a proposal called the Medicaid Continuous Quality Act (MCQA). This policy would make 12-month continuous eligibility standard for most Medicaid enrollees. Currently, this is an option states may provide for children, but not for non-elderly, non-disabled adults in Medicaid. The MCQA would help reduce the number of low-income Americans who lack health insurance coverage and improve the stability, continuity and quality of care they receive. It will ensure more efficient and cost-effective care, both from the perspective of medical and administrative expenses.
ACAP Holds Congressional Briefing on Medicaid Continuous Coverage
ACAP hosted a February 9 Congressional briefing that focused on the problem of “churning” in Medicaid and the implications for the millions of low-income individuals and families who will gain access to Medicaid and subsidized-coverage in Exchanges in 2014. Below are documents from the briefing:
Documents Relating to Continuous Eligibility