Transitioning between Medicaid and Marketplace coverage can create health care potholes for consumers, placing them in harm’s way. Transitioning coverage can be further complicated by challenges with health literacy and health insurance literacy – or understanding how to use health information to make informed health care decisions. Case in point: Connecticut.

July 31st marked the expiration of Connecticut’s Transitional Medicaid Assistance (TMA) option for parents whose Medicaid eligibility was reduced in the 2015 state budget. The transitional Medicaid program assists low-income families’ transition from Medicaid over one year. This experience shines light on two key issues facing consumers who transition between Medicaid and Marketplace coverage—understanding how to select and use health insurance and how to fit health insurance into family budget.

Why were these parents on TMA? In 2015, Connecticut reduced the Medicaid eligibility limit of parents from 201 to 155 percent Federal Poverty Level ($31,140 for a family of three). This resulted in “rollbacks” of parents from Medicaid to Marketplace eligibility. Affected were a small number of parents who were eligible for Medicaid through a category other than income, and the remaining parents who had become ineligible for Medicaid based on income and were poised to lose their coverage—about 14,000 parents. Connecticut Voices for Children led a successful advocacy campaign in 2015 to protect this group of parents from being dropped from Medicaid by highlighting parent’s legal access to Transitional Medicaid Assistance (TMA).

So how did it go? About 41 percent of those eligible enrolled in Marketplace plans, leaving over 8,000 uninsured. It also exposed a more complex set of issues.  Lingering problems remain for low-income consumers—health literacy and plan affordability. These are two longstanding pre-ACA factors that influence the success of a consumer-focused health agenda—not just in Connecticut, but in all states.   


Meeting consumers where they are….and sticking with them.

Connecticut’s effort to transition this group of parents from Medicaid to Marketplace coverage reveals the need for ongoing health literacy support. The literacy required to move from a public to private platform for health coverage is significant and can create confusion—even for veteran enrollment assistance workers. Health literacy is beyond understanding basic health insurance terminology—it is empowering consumers to be active partners in their health decision making, resulting in better health. In Connecticut, advocates supported this initial translation work through the development of their own flyers with clear, plain language instructions for low-income consumers. Advocates shared these resources broadly through their networks as a way to augment those of the Marketplace. Access Health CT also directed its energy and resources toward holding enrollment fairs.

While there are other initiatives to support health literacy underway in Connecticut, in some communities, the outreach and literacy work is largely unfunded. Over the long term, health literacy support and the advancement of broader goals around health improvement cannot be attained without dedicated resources.

Connecticut’s experience is an important reminder that if we really want to reach and improve the health of the “hard-to-reach,” we need assets inside communities to communicate an authentic message that inspires folks to enroll—and use their insurance coverage to improve their health. But is that enough? Even when community partners are heavily involved in outreach and enrollment efforts to aid with the transition, challenges still arise with helping consumers switch coverage in ways to allow them to continue accessing needed care.

Rhode Island illustrates that when you roll back the parent population from Medicaid to Marketplace coverage as they did in 2014, it is challenging to enroll consumers in coverage even with robust outreach and enrollment efforts. For parents, Marketplace plans are unfamiliar and have a more limited benefit package that lacks important supports like transportation and access to in-network clinics or providers.  Further, plans and networks are not aligned across platforms. Consumers’ knowledge of cost-sharing structures and risk-based insurance products offered in Marketplaces is limited. Additional support is needed to help consumers integrate private coverage into their household budget and access additional social service programs that address their financial stability beyond health care coverage. Community partners can play a key role in supporting consumers in this process, connecting them to existing networks of social service partners and working to ensure consumers have ongoing access to affordable, robust coverage.

The road ahead.

The long-term success in Connecticut will be measured during the next enrollment period when enrolled parents are asked to renew their Marketplace plans. Access Health CT understands the importance of assessing consumer experience. Over the coming months, it will conduct focus groups to learn what outreach strategies worked well and whether or not parents are utilizing their new plans. This will be important data to share with community partners so that all stakeholders can work together to improve consumer experience and support consumers in their effort to reach optimal health.

We have much work to do in protecting low-income consumers from high-cost coverage. High on the list are designing Marketplace products that meet the unique needs of low-income consumers and continuing to push for investment in outreach and enrollment and ongoing interactions between enrollers and consumers to promote increased health literacy for all.  As health system stakeholders pave the road for healthy communities, advocates can play a key role in ensuring consumers avoid health care potholes and have seamless access to needed services and supports to keep themselves and their families financially secure and healthy over the long run.