Pursuing health coverage for all children can sometimes feel like pouring water into a leaky bucket. Even when outreach and enrollment efforts are strong, a substantial portion of children will lose their insurance at least once. Unstable insurance coverage, known as “churn,” is inefficient and keeps kids from getting the care they need.

Churn is an especially pervasive problem for children in public insurance programs such as Medicaid and the Children’s Health Insurance Program (CHIP) where families must prove eligibility at regular intervals to renew coverage. Too often, administrative roadblocks lead to children being dropped from the insurance rolls even when household income falls under the eligibility threshold. Because one-third of all children in the U.S. are covered by Medicaid or CHIP, policies aimed at reducing churn in these programs have the potential to make a big impact.

Children with unstable insurance coverage are less likely to have their prescriptions filled or to report a usual source of care. Insurance instability disrupts relationships between patients and primary care providers, decreasing opportunities for preventive care and chronic disease management. During periods of uninsurance, families may delay needed care or visit the emergency department for routine treatment. This is especially problematic for children with conditions such as asthma and diabetes, which can be well-controlled in the primary care setting but cause serious complications when left untreated.

States looking to maximize returns on their limited Medicaid and CHIP funding also have a vested interest in reducing churn. Children who cycle in and out of the programs generate significant costs in the form of extra paperwork, computer system updates, mailings advising enrollees when coverage has been terminated or reinstated, and time spent counseling families on how to regain coverage. Delayed care may also lead to higher medical costs following a coverage gap.

There are steps states and health plans can take to fight back against churn in Medicaid and CHIP. We’ve put together a paper outlining some of the factors contributing to churn and suggesting potential policy strategies to improve retention. As we move forward with outreach and enrollment leading into 2014, it will be equally important to ensure children who are already enrolled stay covered and receive the care they need.

– Ashley Storms, Intern, New England Alliance for Children’s Health