When fully implemented, the Patient Protection and Affordable Care Act will increase the number of insured Americans through two primary strategies – expanding Medicaid and providing insurance through state-based insurance exchanges. As an individual’s household income exceeds the maximum for Medicaid eligibility, he or she will be eligible for subsidies to buy coverage through an exchange, up to a household income of 400 percent of the federal poverty level (FPL). This switch in eligibility also works in reverse. If a person’s household income shrinks below 133 percent of the FPL, he or she will become eligible for Medicaid.
A key design challenge for those tasked with implementing the reform law is how to manage this “churning” phenomenon — when people cycle in and out of public programs as their income varies — so that care is not interrupted.
What approaches are states and the federal government taking to minimize the disruption from churning? Will people be able to keep their provider as they move across the Medicaid-exchange divide? How can private insurers and Medicaid overcome possible technical and cultural barriers to a cooperative working relationship? What issues must states consider as they establish “no wrong door” eligibility determination processes for Medicaid, CHIP and health insurance subsidies?
To address these and related questions, the Alliance for Health Reform and The Commonwealth Fund sponsored a May 20 luncheon briefing. Panelists were: Don Gregory, director of the Louisiana Medicaid program; Deborah Bachrach, former New York Medicaid director now with Manatt, Phelps & Phillips, LLP; and Pamela Short, Pennsylvania State University. Sara Collins of Commonwealth and Ed Howard of the Alliance co-moderated.
Full Transcript (Adobe Acrobat PDF)