Medicaid and Qualified Health Plan Overlap in the Marketplace

Throughout the third annual Health Insurance Marketplace Open Enrollment Period, 12.7 million Americans selected Qualified Health Plans (QHPs) to provide coverage for 2016. Some of these consumers, owing to changes in incomes or other life events, will lose their Marketplace eligibility and gain Medicaid eligibility at some point during the year. The Association for Community Affiliated Plans (ACAP) is interested in better understanding the intersection of Marketplace and Medicaid coverage. Each year, ACAP identifies all QHP issuers offering coverage and highlights those that also serve as Medicaid MCOs in their states. For simplicity, ACAP refers to these issuers as “overlap issuers.”

Overlap issuers could limit the impact of “churn”—the term for enrollees entering and exiting coverage due to unforeseen loss of coverage. Churn between Medicaid and the Marketplaces can be caused by minor fluctuations in income, and movement of individuals between these two coverage settings is expected to be substantial. Historically, miscellaneous clerical errors, failure to renew enrollment on a timely basis, and other factors have contributed to significant amounts of churn from the Medicaid program.

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