OR: Medicaid Advisory Panel Considering Strategies to Address “Churn”


Oregon’s Medicaid Advisory Committee is conducting an environmental assessment over the next six months to develop recommendations for addressing Medicaid “churn,” which refers to when people switch into and out of Medicaid because of income changes that affect their eligibility.  Problems that can be caused by churn include disruption of care, network changes and potential cost-sharing increases.

As a result of the Affordable Care Act implementation, many more people are expected to churn between Medicaid and subsidized private health plans purchased in the new exchange marketplaces.  A recent article in Health Affairs estimates that more than 40 percent of adults likely to enroll in Medicaid or subsidized qualified health plans will churn between Medicaid and QHPs within a 12-month period.

During the advisory committee’s meeting last week, consultants with Manatt Health Solutions provided an overview of options for addressing churn.

Deborah Bachrach, a Manatt consultant, advised the committee that “none of [these strategies] are perfect,”  and that all of them have various impacts on affordability, administration, and access.

“You have to think through what you’re solving for, and how do you make it as seamless and aligned as possible,” added Jeanene Smith, director of Oregon’s Office for Health and Policy Research.  Smith is working closely with the panel to craft the recommendations.

One option is to create a basic health plan. Under a the Affordable Care Act, a basic health plan would function as  a state-run subsidized health plan, like the Oregon Health Plan, for adults who make between 139 percent and 200 percent of the federal poverty level.

Some lawmakers in Washington have been looking into reviving the state’s much-lauded basic health plan, and Oregon is currently conducting a feasibility study on establishing one.

Another option is a so-called “bridge plan” to cover individuals once they come off Medicaid and are waiting to enroll in a qualified health plan, or vice-versa.

Such a plan would allow the state’s coordinated care organizations (CCOs) to offer QHPs through Cover Oregon.  Enrollment would be limited to people transitioning between the Oregon Health Plan and QHPs, and could potentially eliminate mixed family coverage.

Last year, Washington state considered starting a bridge plan called Apple Health Plus, but apparently that idea is on hold.

Providing continuous Medicaid coverage to adults for one year, regardless of income fluctuation, is another option.  A waiver from the Centers of Medicare and Medicaid (CMS) would be needed.

The advisory committee is expected to narrow down which options to pursue in-depth during its next meeting on April 23.