Churn, Continuous Eligibility, and Medicaid: the Safety Net Health Plan Perspective Georganne Chapin...
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Transcript of Churn, Continuous Eligibility, and Medicaid: the Safety Net Health Plan Perspective Georganne Chapin...
Churn, Continuous Eligibility, and Medicaid: the Safety Net
Health Plan Perspective
Georganne ChapinPresident & CEO
Hudson Health PlanHudson Center for Health Equity &
QualityTarrytown, NY
[email protected] 10, 2009
Overview
An Illustration of the Problem
Impact on Enrollees
Impact on Providers, State Medicaid Programs, and Managed Care Organizations
Churn in the Context of Health Reform
Solutions: Safety Net Health Plan Action Steps
Churn: An Illustration of the Problem
Problem: Significant portion (nearly 35%) of Hudson Health Plan’s Medicaid members are involuntarily disenrolled each year.
Why? Many lose coverage because of undetected change of address.
Impact on Enrollees Individuals and families left vulnerable to illness and injury.
Patients experience gaps in ongoing treatments and preventive services.
Breaks in coverage cause: Delays and interruptions in care Increased health risks Potential for significant future health problems Poor health!
Impact on Providers, State Medicaid Programs, and MCOs
Providers: Forced to choose between providing uncompensated care & turning patients away.
State Medicaid Programs: Added administrative burden of processing unnecessary disenrollments and enrollments.
Medicaid Health Plans: Gaps in critical contact with patients, breaks in care coordination, impaired quality monitoring and improvement activities.
Churn in the Context of Health Reform Goal of National Health Reform: Universal coverage
for all Americans. Constant churn prevents universal coverage. While Senate Finance Committee options document included 12-
month continuous coverage mandate for Medicaid, Other proposals silent.
Measure and improve health care quality Quality monitoring/improvement required for Medicaid
MCOs, but MCOs cover fewer than half of enrollees. No federal requirements for comparable monitoring/improvement
for PCCM & FFS enrollees.
Solutions: Safety Net Health Plan Action Steps Hudson Health has actively worked toward increasing Medicaid
continuous eligibility:1. At the plan-level:
Educating members about renewal requirements
Streamlined renewal programs Hcheq: FEEA & EnrollNY
2. At the national policy level:
Developing Medicaid continuous eligibility policy with ACAP & GW
Questions?