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Medicaid and CHIP are a lifeline for many low-income Americans, providing health care coverage when they need it most. However, these important programs can be further improved so they provide coverage we can count on. There are two clear areas for improvement.

First, enrollment in Medicaid and CHIP – unlike private insurance or Medicare – is like a sieve; every year millions of people enroll, only to subsequently lose their coverage, despite still being eligible. These interruptions in coverage, widely known as "churn," harm the continuity and effectiveness of care.

Second, there is currently no nationwide, mandatory and standardized way to measure, report, or improve the quality of services across the entire Medicaid program. That means that CMS, federal and state governments, and taxpayers cannot systematically evaluate the quality of care that Medicaid enrollees are receiving nationwide, from state to state, or even through varying delivery systems within a state.

Legislative proposals to address both these issues exist, which will truly make Medicaid coverage we can count on. Urge your Member of Congress to support these important initiatives. Read on for more background.


The Average Medicaid Enrollee Is In the Program 9.7 Months of the Year

How Does Your State Compare?

State-By-State Rates of
Overall Enrollment Continuity

Children | Non-elderly adults 
SeniorsBlind/disabledData Tables

Representatives Gene Green and Joe Barton have introduced the bipartisan H.R. 2628, The Stabilize Medicaid and CHIP Coverage Act of 2015. Senator Sherrod Brown has introduced similar legislation, S. 1227, in the Senate. These bills provide 12-month continuous eligibility for all Medicaid and CHIP enrollees.

Currently, the average Medicaid enrollee is on the program less than 10 months per year – see how your state compares. While some enrollees leave the Medicaid program owing to rising incomes, many are instead "churned": disenrolled and reenrolled in the program owing to bureaucratic and paperwork problems, or because they had a couple of extra hours of overtime in a week. The Stabilize Medicaid and CHIP Coverage Act would reduce the number of low-income Americans who lack health insurance coverage and improve the stability, continuity and quality of care they receive. It will ensure more efficient and cost-effective care, both from the perspective of medical and administrative expenses.

For more information about how unstable coverage affects the millions of Americans who rely on Medicaid and CHIP, review the churn FAQs.


Last year, Representatives Diana DeGette and Joseph P. Kennedy introduced H.R. 5542, The Medicaid and CHIP Quality Improvement Act of 2016. Senator Sherrod Brown also introduced S. 2438, a bill by the same title. This legislation, which is expected to be reintroduced in the 115th Congress, would establish a nationwide system to measure the quality of care provided to people with Medicaid and CHIP. Right now, there is no way to compare and improve the quality of care provided in different states, or even in different delivery systems in the same state. Without such a system in place, efforts to reform the Medicaid program cannot effectively focus on improving quality of care. Instead, changes must rest on cuts to vital benefits or payments to plans and providers, none of which will improve the health of enrollees, access to care or participation of high-quality providers in the program. The establishment by Congress of a nationwide system to uniformly measure, report, and improve the quality of care to Medicaid enrollees – across all types of delivery systems – will be an important step forward.

For more information on why a standardized, nationwide quality reporting and improvement system is necessary, refer to the quality FAQs.

The bills are positive steps, increasing equity, transparency and accountability in the Medicaid and CHIP programs while also ensuring people with Medicaid and CHIP have coverage they can count on.

Letters of support from Medicaid stakeholders are available here.