policy

Medicaid covered 72.0 million beneficiaries in July 2015 (also including Children’s Health Insurance Program enrollees), making it the nation’s largest insurance program. Although 20 states are not currently expanding or planning to expand Medicaid, participation has grown by 13.2 million since mid-2013.Medicaid offers primary, preventive, acute and long-term care insurance coverage to low-income children, adults, elderly and people with disabilities, who would otherwise have difficulty affording insurance. It provides affordable health coverage with relatively low cost-sharing burdens for impoverished beneficiaries. Medicaid can improve access to care and even reduce mortality and is less expensive than private insurance coverage.

While millions of people gain entry to Medicaid every year, millions are dropped from the program, even though many are still eligible. They may reapply and reenroll at a later time, thus “churning” off and back on to Medicaid. Interruptions in coverage can be caused by many factors, including minor fluctuations in income, moving to another area, failure to submit periodic reports to update records about income or other factors, or being unable to renew enrollment on a timely basis. After people lose Medicaid coverage, they may become uninsured or shift to another form of insurance, such as a Health Insurance Marketplace plan or other private coverage.

This conundrum frustrates and confuses both patients and health care providers and can compromise both access to and quality of care. From a patient’s perspective, the loss of Medicaid may mean that she cannot afford to see a doctor or get a prescription during the period
without coverage. If some of their patients experience coverage gaps, physicians and other clinicians might not be reimbursed for medical care they provided.

Even if a patient shifts from Medicaid to another type of insurance, problems may occur because provider networks or insurance requirements often differ between Medicaid and the other insurer, so that patients may be unable to get care from the same physicians or experience delayed or fragmented care. In all these cases, the loss of continuous enrollment creates gaps that can have adverse consequences.

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