Report: Nearly Half of Issuers Offering Marketplace Coverage Operate Medicaid Managed Care Plan in the Same State
FOR IMMEDIATE RELEASE: June 6, 2018
FOR MORE INFORMATION: Jeff Van Ness, (202) 204-7515
REPORT: NEARLY HALF OF ISSUERS OFFERING MARKETPLACE COVERAGE OPERATE
MEDICAID MANAGED CARE PLAN IN THE SAME STATE
WASHINGTON—An ACAP analysis of issuers offering Qualified Health Plans (QHP) through Marketplaces for the 2018 coverage year has found that 48 percent of such issuers offer Medicaid managed care coverage in the same state, a modest increase from the year before. It also finds a drop in the number of QHP issuers of nearly 20 percent, from 237 in 2017 to 192 this year.
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, and to patients delaying or foregoing care or medications. It can also force patients who re-enroll in new coverage to find a new primary care provider should they choose a plan offered by a different issuer. With similar or identical provider networks and customer-service contacts, overlap issuers can mitigate these effects. 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 consistently noted that overlap issuers have an important role to play for families and others who have to navigate more than one coverage ecosystem,” said ACAP CEO Margaret A. Murray. “It’s important to note their role in consumer choice, and in an ideal world consumers would have ready access to information such as this.”
County-Level Analysis Shows Disparity in Overlap Plan Distribution
A county-level analysis demonstrates that a large number of overlap issuers at a state level does not guarantee all residents of the state abundant coverage options; in fact, the option for residents to enroll in plans within their service areas that operate in both the Marketplace and Medicaid may be limited. For instance nearly half of all counties in Texas (48%) have no overlap issuers, and just six percent of all Texas counties have more than one overlap issuer available. This is in vivid contrast to New York, where 87 percent of New York counties have two or more overlap issuers.
The full study and complete list and analysis of QHP issuers is available at www.communityplans.net.
ACAP represents 61 not-for-profit Safety Net Health Plans, which provide health coverage to more than 21 million people in 29 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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