Challenge of dealing with "churning" of Medicaid enrollees

State Medicaid officials, private insurers and healthcare providers face a big challenge in dealing with the “churning” of Medicaid enrollees.

The term “churn” refers to people who move back and forth between Medicaid, private insurance and no insurance as their income fluctuates. That's expected to be a bigger issue as millions of low-income adults become eligible for expanded Medicaid under Obamacare. Switching plans can cause disruption in care as patients lose access to existing providers.

A recent Health Affairs study found that 32% of people signed up for Medicaid or Obamacare coverage will experience a change in eligibility within six months of enrollment.

The churning issue will be discussed this week at a three-day Medicaid managed-care conference in Baltimore, sponsored by the Institute for International Research and starting May 19.

One way that discontinuity of coverage and care can be avoided is having more health plans offer both Medicaid and private coverage through the insurance exchanges so people can stay in the same plan if their eligibility changes, said Deborah Bachrach, a partner at Manatt Phelps & Phillips and former New York state Medicaid director.

States should develop ways to create more congruity in benefits between Medicaid and private-market plans, Bachrach said. She suggests eliminating Medicaid's benefit for non-emergency transportation while requiring private plans to pay for after-hour visits in non-urgent care settings. “The push and pull will work for everyone's benefit,” Bachrach said at a recent conference.

Follow Virgil Dickson on Twitter: @MHVDickson