Medicaid and Marketplace Eligibility Changes Will Occur Often In All States

Policy Options Can Ease Impact

Health Affairs March 2014 cover

Under the Affordable Care Act (ACA), changes in income and family circumstances are likely to produce frequent transitions in eligibility for Medicaid and health insurance Marketplace coverage for low- and middle-income adults.

The researchers provide state-by-state estimates of potential eligibility changes (“churning”) if all states expanded Medicaid under health reform, and they identify predictors of rates of churning within states.

Combining longitudinal survey data with state-specific weighting and small-area estimation techniques, they found that eligibility changes occurred frequently in all 50 states. Higher-income states and states that had more generous Medicaid eligibility criteria for nonelderly adults before the ACA experienced more churning, although the differences were small. Even in states with the least churning, they estimated that more than 40 percent of adults likely to enroll in Medicaid or subsidized Marketplace coverage would experience a change in eligibility within 12 months.

Policy options for states to reduce the frequency and impact of coverage changes include adopting 12-month continuous eligibility for adults in Medicaid, creating a Basic Health Program, using Medicaid funds to subsidize Marketplace coverage for low-income adults, and encouraging the same health insurers to offer plans in Medicaid and the Marketplaces.

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