Churn, Continuous Eligibility, and Medicaid: the Safety Net Health Plan Perspective

1. Churn, Continuous Eligibility, and Medicaid: the Safety Net Health Plan Perspective Georganne Chapin President & CEO Hudson Health Plan Hudson Center for Health Equity & Quality Tarrytown, NY   gchapin@hudsonhealthplan.org July 10, 2009

3. 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

4. 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.

5. 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!

6. 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.

7. 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.

8. Solutions: Safety Net Health Plan Action Steps • Hudson Health has actively worked toward increasing Medicaid continuous eligibility: • At the plan-level: • Educating members about renewal requirements • Streamlined renewal programs • Hcheq: FEEA & EnrollNY • At the national policy level: • Developing Medicaid continuous eligibility policy with ACAP & GW

9. Questions?