H.R. 1698 Would Bring Enrollment Stability to Medicaid, CHIP Programs

Representatives Gene Green (D-Texas) and Joe Barton (R-Texas) recently introduced H.R. 1698, the Stabilize Medicaid and CHIP Coverage Act of 2013, which would provide for 12-month continuous enrollment for Medicaid and CHIP. Every year millions of people enroll in the two programs, only to subsequently lose their coverage despite still being eligible. Many otherwise-eligible beneficiaries are continuously disenrolled and reenrolled in the program owing to bureaucratic and paperwork problems, or small and often temporary changes in income. These income changes can stem from items as simple as getting a few extra hours of overtime in a week. Such interruptions have an adverse effect on the continuity and quality of care.

“ACAP applauds Representatives Green and Barton for their leadership in seeking to provide Medicaid and CHIP beneficiaries with a source of coverage they can count on,stabilizing health care services for those who need it most," said ACAP CEO Margaret A. Murray in a statement. “Providing 12 months of continuous enrollment in Medicaid and CHIP brings these critical programs in line with private health plans, Medicare and other health care programs.We call upon other Members of Congress to join Reps. Barton and Green and promptly pass the Stabilize Medicaid and CHIP Coverage Act."

ACAP has developed a Web site that provides a wide range of resources on "churn" and its ill effects, including maps detailing the variance in enrollment continuity rates among various subgroups and from state to state. For more details, visit coverageyoucancounton.org.

Report: Medicaid Beneficiaries Covered Only Part of the Year; Poorer Health, Higher Costs Result

A new report authored by health policy researchers at George Washington University shows that the average Medicaid beneficiary is covered for only part of the year, leading to poorer health, higher-cost episodes of care, and frustrating the efforts of providers and others to deliver top-quality health care.

This is due in large part to the phenomenon of “churn,” where otherwise-eligible beneficiaries are disenrolled and reenrolled in the program owing to paperwork issues or small and often temporary changes in income. “Churn” leads millions of Medicaid beneficiaries to be removed from the program despite no change in their underlying eligibility. The on-again-off-again cycle of enrollment results in the disruption of care for people with low incomes, leads to higher monthly medical expenses, interferes with efforts to assess the quality of care delivered through the Medicaid program, and diverts resources from clinical care to eligibility assistance. 

Press Release | Updated Report

Tricia Berke Vinson Wins ACAP Leadership in Advocacy Award

ACAP named Tricia Berke Vinson, Directing Attorney of the Health Consumer Center for the Legal Aid Society of San Mateo (Calif.) County, the winner of the ACAP’s first Leadership in Advocacy Award. Ms. Vinson was recognized for her efforts to help low-income residents of San Mateo County overcome barriers to health care and for her staunch advocacy at the state and local level for policies that improve access to health care for vulnerable populations. Ms. Vinson was recognized for her efforts to alleviate the the burden of Medi-Cal cost sharing. She created a monthly Share of Cost Clinic staffed by a team of pro bono volunteer attorneys from Facebook and Fenwick & West, a nearby law firm. These clinics have resulted in hundreds of beneficiaries gaining full access to Medicaid services.  She also worked closely with state and county agencies to help seniors and persons with disabilities to apply for Medicare Part A and Part B through the Medicare Savings Program, a program where states help qualified beneficiaries pay their Medicare premiums. Read the release.

ACAP Report Proposes Improvements to Risk Adjustment in Health Insurance Exchanges

A new report issued by ACAP examines efforts by the Federal government to promote stability in the new Health Insurance Exchange markets created by the Affordable Care Act. The report, written by Tony Dreyfus and Ellen Breslin Davidson of BD Group, outlines challenges to effective risk adjustment and payment accuracy for plans that focus on serving low-income individuals who will access health coverage through the Exchanges.

Risk adjustment is a mechanism widely used that improves the accuracy of payments to health plans and provides health plans that take on sicker populations with higher levels of revenue. Risk adjustment encourages health plans to serve members with high health care needs, such as those with a chronic illness or disability. ACAP-member Safety Net Health Plans face particular challenges as they move toward participating in the Exchanges. The paper, Improving Risk Adjustment in the Health Exchanges to Ensure Fair Payment, makes several proposals to strengthen risk adjustment to reflect more accurately the risk taken on by plans focused on serving vulnerable populations.  

ACAP Fact Sheet Profiles Safety Net Health Plan Efforts to Reform the Health Care Delivery System

A new ACAP fact sheet details how Safety Net Health Plans are working to change the way health care is delivered to their more than 9.5 million members across the country.

ACAP-member Safety Net Health Plans and the providers with whom they partner continuously develop creative approaches to maximize the limited set of available health care resources in an effort to make the system more efficient and effective. The paper looks at four initiatives that seek to improve quality, expand access, contain costs, or a combination of the three.

Press release | Report

ACAP Report Shows How States Can Improve Medicaid Programs Through Managed Care

An ACAP fact sheet profiles the ways in which state policymakers can improve the quality of the care delivered through their Medicaid programs through managed care. Surging Medicaid enrollments and tightened budgets have led state policymakers to take a close look at the value delivered by their Medicaid programs. Accordingly, many states are turning to managed care organizations in an effort to promote quality and value. The fact sheet shows how states that contract with managed care organizations have a wide variety of policy levers at their disposal to help promote high-quality care.

Fact Sheet | Press Release

ACAP-Commissioned Paper Proposes New Model of Care, Financing for Dually Eligible Beneficiaries

A new paper commissioned by ACAP and written by researchers from the George Washington University School of Public Health & Health Services outlines a new proposal for providing care to individuals eligible for both Medicare and Medicaid, or “dual eligibles.” The new state plan option, which ACAP has dubbed the Very Integrated Program (VIP), would be a distinct, permanent program featuring a fully-integrated, capitated model of care that can be chosen by states through a permanent choice within the Medicaid State Plan.  

Read the proposal | Executive summary | Press Release | Slides