Churn, Continuous Eligibility, and Medicaid: the Safety Net

Health Plan Perspective

Georganne ChapinPresident & CEO

Hudson Health PlanHudson Center for Health Equity &

QualityTarrytown, NY  

gchapin@hudsonhealthplan.orgJuly 10, 2009

Overview

An Illustration of the Problem

Impact on Enrollees

Impact on Providers, State Medicaid Programs, and Managed Care Organizations

Churn in the Context of Health Reform

Solutions: Safety Net Health Plan Action Steps

Churn: An Illustration of the Problem

Problem: Significant portion (nearly 35%) of Hudson Health Plan’s Medicaid members are involuntarily disenrolled each year.

Why? Many lose coverage because of undetected change of address.

Impact on Enrollees Individuals and families left vulnerable to illness and injury.

Patients experience gaps in ongoing treatments and preventive services.

Breaks in coverage cause: Delays and interruptions in care Increased health risks Potential for significant future health problems Poor health!

Impact on Providers, State Medicaid Programs, and MCOs

Providers: Forced to choose between providing uncompensated care & turning patients away.

State Medicaid Programs: Added administrative burden of processing unnecessary disenrollments and enrollments.

Medicaid Health Plans: Gaps in critical contact with patients, breaks in care coordination, impaired quality monitoring and improvement activities.

Churn in the Context of Health Reform Goal of National Health Reform: Universal coverage

for all Americans. Constant churn prevents universal coverage. While Senate Finance Committee options document included 12-

month continuous coverage mandate for Medicaid, Other proposals silent.

Measure and improve health care quality Quality monitoring/improvement required for Medicaid

MCOs, but MCOs cover fewer than half of enrollees. No federal requirements for comparable monitoring/improvement

for PCCM & FFS enrollees.

Solutions: Safety Net Health Plan Action Steps Hudson Health has actively worked toward increasing Medicaid

continuous eligibility:1. At the plan-level:

Educating members about renewal requirements

Streamlined renewal programs Hcheq: FEEA & EnrollNY

2. At the national policy level:

Developing Medicaid continuous eligibility policy with ACAP & GW

Questions?