Study: 4 Of 10 Marketplace Issuers Offer Medicaid Managed Care Coverage In The Same State

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“Overlap” Issuers Could Mitigate Effects of ‘Churn’ Between Marketplace, Medicaid;
Close Analysis Shows Clustering of Such Issuers Within States

WASHINGTON—An ACAP analysis of issuers offering Qualified Health Plans through Marketplaces in 2016 finds that 137 of 335 such issuers—or just over 40%—also offer Medicaid managed care coverage in the same state. A county-level analysis of such “overlap issuers,” however, suggests that many individuals, even those residing in states with large numbers of overlap issuers, have limited access to plans that operate in both Medicaid and the Marketplace.

Overlap issuers can soften the effect of churn for a group of people who move between eligibility for Medicaid programs and subsidized coverage offered through Marketplaces. Small, short-term changes in income can shift working adults with low incomes out of Medicaid eligibility and into Marketplace coverage, or vice versa. These income fluctuations can be the result of seasonal employment, receiving a few extra or fewer hours at work, or even a month that has five weeks rather than four.

Some of the more serious aspects of churn involve interruptions in coverage; people who churn off of Medicaid or Marketplace coverage often delay or forego care, or leave prescriptions unfilled because they cannot afford them. Others, despite immediately re-enrolling in new coverage, may need to find a new primary care provider should they enroll in a Medicaid or Marketplace health plan offered by a different issuer.

Overlap issuers may mitigate some of these 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.

“We’ve come a long way in expanding affordable coverage options across the spectrum of incomes, but a few rough edges are still there,” said ACAP CEO Margaret A. Murray. “Switching plans under any circumstances can disrupt treatment regimens or doctor-patient relationships. Highlighting these overlap issuers points up an option for consumers that might help to smooth the transition.”

The report found that the number of overlap issuers nationwide increased to 137 from 131 last year.

Marketplaces in 36 states include at least one overlap issuer, up from 33 last year. 


County-Level Analysis Suggests Uneven Distribution of Overlap Plans
To provide a more precise measure of overlap in two of the nation’s largest Marketplaces, ACAP performed a county-level analysis of issuers in New York and Texas. It found that even states with high numbers of overlap insurers do not necessarily offer all residents of that state the option to choose plans within their service areas that operate in both the Marketplace and Medicaid.

Marketplaces in Texas and New York each feature twelve overlap issuers this year. However, in Texas, nearly 70 percent of counties in the State have no overlap issuers. Just 12 percent have more than one overlap issuer available–suggesting that consumers have fewer opportunities to select an overlap issuer than a state-level analysis suggests at first blush.

In contrast, every county in New York includes at least one overlap issuer. Two-thirds have two or more. And the average number of overlap issuers in New York counties is more than four times greater than that of Texas counties.

“In New York and Texas, consumers in big cities tend to have more choice,” added Murray. “That’s not particularly surprising, but the degree to which the difference exists in Texas is striking. This particular finding shows that just like in politics, all health care is local.”

The complete list and analysis of QHP issuers is available at; more information about churn is available at

About ACAP
ACAP represents 56 not-for-profit Safety Net Health Plans, which provide health coverage to more than fifteen million people in 26 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

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