I was delighted to see MACPAC’s recent examination of continuous coverage and churn in Medicaid and CHIP. It was the first such analysis I’ve seen using data from the Transformed Medicaid Statistical Information System (T-MSIS) from 42 states and D.C. While the analysis includes all non-elderly Medicaid enrollees, I’m going to focus mostly on the findings for children (in italics below).
The good news is the analysis indicates that the overall average length of enrollment is 11.7 months for children, compared to prior studies reflecting around 10 months. This means it won’t take much money to close this gap.
Now, you might be wondering why continuous eligibility is so important if children, on average, are enrolled for almost a year.
- Despite the average length of enrollment, 19 percent of children lost coverage at some point in 2018. Nearly half (9 percent) re-enrolled within a year (aka churn).
More importantly, children do not fare equally well depending on where they live. During the Trump administration, states were encouraged to impose administrative barriers, including periodic data checks, which led to a reversal of more than a decade of progress in reducing the number of uninsured children, as my colleagues, Joan Alker and Aubrianna Osario write in this companion blog.
- Children in states with periodic data checks were two-thirds less likely to have full year coverage. (14.5% vs. 8.6%). Take Texas, for example. The state was conducting multiple monthly income checks leading to more than 4,000 children losing Medicaid coverage each month when families were unable to respond with proof of eligibility within 10 days.
In addition to inequities by state, some moderate-income children have access to continuous coverage while lower income children do not. While states have the option to adopt 12-month continuous eligibility for both programs, only 24 states do so in Medicaid, while 26 of 34 states with separate CHIP programs keep kids enrolled for a full year. The fact is that lower-income families are more likely to experience income fluctuations, have fewer options to transition to other coverage, and have less financial ability to cover costs of care while uninsured.
- Children in the states without continuous eligibility were nearly 50% more likely to have less than a full year of coverage. (4.1% vs. 2.8%).
Continuous eligibility is also a powerful way to address health disparities. Medicaid and CHIP are primary sources of health coverage, especially for children of color because they are more likely to be economically disadvantaged.
- Black and Latino enrollees were more likely to experience churn than White enrollees
There are so many reasons why continuous coverage is important for children, as I noted in this recent brief. Continuous health insurance coverage produces a broad array of benefits across the health care sector for individuals, states, health plans, and providers.
In particular, Medicaid continuous eligibility promotes health equity by limiting gaps in coverage for low-income children and adults who experience disproportionate rates of health disparities. Consistent access to health care, including management of chronic conditions and care coordination, improves health status and well-being and drives more efficient health care spending. Importantly, continuous eligibility mitigates the negative effects of income volatility that disproportionately impact low-income families and essential workers. By reducing the administrative costs associated with enrollees cycling on and off of Medicaid due to temporary fluctuations in income, states can dedicate more of the Medicaid dollar to pay for health care. Moreover, continuous eligibility is necessary to fully measure the quality of health care in Medicaid and the Children’s Health Insurance Program (CHIP), which also opens the door to improved accountability and oversight of insurers, including Medicaid managed care plans.
And consider this. A recent study by the Federal Reserve Bank of Minneapolis found that early childhood Medicaid eligibility increases employment and reduces mortality up to 50 years later. The research examined young children covered by Medicaid in the 1960s and 1970s and determined that they grew up to be healthier adults who work more and receive public assistance less often. The author concludes that childhood Medicaid coverage, especially for the program’s poorest recipients, delivers large benefits later in life to both covered individuals and to the government.
The MACPAC analysis shows that guaranteeing a full year of coverage in Medicaid and CHIP for children is not a heavy financial lift. The reality is 12-month continuous eligibility is an investment that pays off in the long run.
[Editor’s Note: Tricia Brooks serves as a Medicaid and CHIP Payment and Access Commission (MACPAC) Commissioner, however, the views expressed in this blog are her own not those of the commission. MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and the Children’s Health Insurance Program (CHIP). The U.S. Comptroller General appoints MACPAC’s 17 commissioners, who come from diverse regions across the United States and bring broad expertise and a wide range of perspectives on Medicaid and CHIP.]