One of the goals of the Affordable Care Act (ACA) is to increase the number of people who have access to health insurance, no matter what their life or economic circumstances. We are all working hard to ensure the ACA fulfills this promise, by getting people enrolled.
But what happens to people when their circumstances change? Economists think as many as 28 million people—50 percent of adults with incomes below 200 percent of the federal poverty level—could face eligibility changes that cause them to shift between Medicaid and Marketplace coverage (pay-gated). In some cases, this will mean an administrative hassle (both for the consumer and the state), but the stakes could be as high as loss of all coverage, especially in states that have yet to expand Medicaid. This situation—bouncing between types of coverage, or cycling in and out of coverage—is known as churn.
Churn is a persistent and challenging characteristic of our health insurance landscape. Churn can disrupt care by interrupting the patient-provider relationship, complicating access to medications, or causing a consumer to delay care; moving in and out of coverage also leaves consumers at risk of incurring significant financial burdens.
The effects of churn can be especially problematic for children, many of whom are covered through Medicaid and the Children’s Health Insurance Program (CHIP). Kids require frequent contact with the health care system for preventative services, developmental needs, and routine and acute care, and barriers to care—including sporadic or frequently changing coverage—can have long-term consequences.
The causes of churn can be challenging to pinpoint. This uncertainty complicates efforts to reduce the burden faced by both families and states. Many different factors can contribute to churn, and these causes require carefully tailored policy solutions.
To help our partners address this issue, Community Catalyst is released a Churn Toolkit. The toolkit includes several helpful materials to help you learn about churn, ask questions in your states and some success stories in states that have reduced churn.
We are excited to work on tackling this problem, so click over to the toolkit and give it a look! Let us know what works and what needs improvement. Together, we can make progress on keeping consumers enrolled in coverage.