Overlap Between Medicaid Health Plans and QHPs in the Marketplaces: An Examination in 2018

More than 11 million consumers signed up for coverage through Health Insurance Marketplaces for 2018.[1] In 2017, over 2 million people who signed up for coverage did not effectuate their coverage—that is, did not pay their premiums—by June. Additionally, owing to changes in income or other life events, some Marketplace consumers will only be enrolled for part of the year; in fact, trends in Marketplace enrollment show such drops in coverage over the year are typical.[2] Some of these consumers become uninsured; others may switch to a group plan through their job. Still others will gain Medicaid eligibility at some point during the year.

The cycle of enrollees entering and exiting insurance coverage, often due to unexpected loss of coverage, is described as “churn.” Churn between Medicaid and the Marketplaces can be caused by minor fluctuations in income. In addition, clerical errors and failure to renew enrollment on a timely basis, among other factors, have historically contributed to churn from the Medicaid program. The Association for Community Affiliated Plans (ACAP) is interested in better understanding the crossroads of Marketplace and Medicaid coverage. Qualified Health Plan (QHP) issuers that also serve as Medicaid managed care organizations (MCOs), which ACAP refers to as “overlap issuers,” are at the interface of Marketplace and Medicaid coverage and limit the impact of churn on enrollees.

Each year, ACAP identifies all QHP issuers offering coverage and highlights those that also serve as MCOs in their states. ACAP’s survey of the extent to which products offered by overlap issuers are available on the Marketplaces finds the following for the 2018 benefit year:

  • The total number of QHPs participating in the Marketplace[3] fell from 237 to 192, a 19% drop.
  • 93 of the 192 QHP issuers (48%) offering Marketplace offer Medicaid MCOs in the same state, a slight increase in overlap coverage compared with the first four Open Enrollment Periods.
    • Nationally, the number of overlap issuers decreased by 12 issuers, an 11% drop.
  • Marketplaces in 34 states include at least one overlap issuer—one more state than last year.
    • Of the 33 states with at least one overlap issuer in 2017, 12 had fewer overlap issuers in 2018.

View the full study here (.pdf) »

Download the analysis spreadsheet (.xlsx) »

[1] CMS. (2018). “Final Weekly Enrollment Snapshot for 2018 Open Enrollment Period.” https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-12-28.html.

[2] CMS. (2017). “First Half of 2017 Average Effectuated Enrollment Report.” https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-12-13-2.html.

[3] ACAP counted the number of unique issuers offering QHP plans in each state. As an example, CareSource offers QHP plans in four different states. Under this methodology they are counted as four issuers rather than one.