FOR IMMEDIATE RELEASE: January 31, 2016
FOR MORE INFORMATION: Jeff Van Ness, (202) 204-7515
REPORT: 44 PERCENT OF MARKETPLACE ISSUERS OFFER MEDICAID MANAGED CARE COVERAGE IN THE SAME STATE
“Overlap” Issuers Could Reduce ‘Churn’ Between Marketplace, Medicaid; Opportunities to Better Inform Consumer Choice Persist
WASHINGTON—An ACAP analysis of issuers offering Qualified Health Plans through Marketplaces for the 2017 coverage year find 105 of 237 such issuers—44%— offer Medicaid managed care coverage in the same state. A county-level analysis of such “overlap issuers” suggests that in many counties, even in states with large numbers of overlap issuers, consumers have limited choices for plans that operate in both Medicaid and the Marketplace.
Overlap issuers can soften the effect of “churn,” a phenomenon where people move between eligibility for Medicaid programs and subsidized Marketplace coverage. Minor fluctuations in income can shift working adults with low incomes out of Medicaid eligibility and into Marketplace coverage, or vice versa. These fluctuations can arise from seasonal employment, extra or fewer hours at work, or even a month that has five weeks rather than four.
Churn can lead to interruptions in coverage. People who churn off of Medicaid or Marketplace coverage often delay or forego care or medications. Others, despite immediately re-enrolling in new coverage, may need to find a new primary care provider should they enroll in a plan offered by a different issuer. Overlap issuers can mitigate such effects as their provider networks and customer-service contacts are often similar or the same. They may also streamline access to care for families with “split eligibility,” where working parents may receive subsidized coverage through a Marketplace plan while their children are covered by a health plan offered by the same issuer under a Medicaid or CHIP program.
“With the Marketplace and Medicaid facing uncertainty in the years ahead, consumers are concerned about the choices they may have going forward,” said ACAP CEO Margaret A. Murray. “Overlap issuers can make the transition smoother when people move between coverage environments.”
County-Level Analysis Suggests Uneven Distribution of Overlap Plans
A county-level analysis of issuers in New York and Texas, two of the states with the highest number of overlap issuers, highlights the disparity in the level of choice that consumers have in choosing insurers that operate both Marketplace and Medicaid plans in their service area.
There are twelve overlap issuers in New York this year, and seven in Texas. In Texas, however, more than 90 percent of counties in the State have just one overlap issuer, or none at all. In contrast, every county in New York includes at least one overlap issuer, and four in five have two or more; The average number of overlap issuers in New York counties is more than five times greater than that of Texas counties.
The full study and complete list and analysis of QHP issuers is available at www.communityplans.net.
ACAP represents 59 not-for-profit Safety Net Health Plans, which provide health coverage to more than seventeen million people in 28 states. Safety Net Health Plans serve their members through Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), the Marketplace and other health programs. For more information, visit www.communityplans.net.
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