Center on Budget & Policy Priorities: States Can Improve Transitions Between Medicaid and the Marketplace
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States that run their own state-based health insurance marketplaces (SBMs) are uniquely positioned to help people no longer eligible for Medicaid transition to a marketplace plan and receive financial help if they qualify, as the state administers both the SBM and Medicaid. Thirteen of the 17 states (and
Complexity Can Leave People Uninsured
The Affordable Care Act (ACA) envisioned a "no wrong door" policy, in which people can apply using a single, streamlined application and then enroll in the health coverage they are eligible for, whether that's Medicaid, a marketplace plan, or another program. But this vision has not been fully realized. Typically, someone who loses Medicaid needs to take a series of actions to successfully transition to the marketplace, including figuring out how and where to apply, completing an application, selecting a plan, and submitting any required documentation. People may also experience delays as the state processes their application. These challenges can put people at risk of becoming uninsured or experiencing gaps in coverage,/2 despite being eligible for no- or low-cost coverage.
Many people who lose coverage during unwinding are likely still eligible for Medicaid, but some have experienced changes that make them eligible for a marketplace plan instead. States with SBMs are employing various strategies to help these individuals access affordable coverage through the marketplace with reduced administrative burden.
State Strategies
Automatic and Streamlined Transitions
Five states are attempting to lessen the potential for coverage loss by cutting the number of steps to transition from Medicaid to a marketplace plan.
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Single Eligibility Determination
At least ten states and D.C. have long used a single system to determine eligibility for both Medicaid and the marketplace./10 This can lead to faster - and in some cases, instantaneous - eligibility determinations. States have implemented this approach by using a single application for both programs, integrating databases, and/or ensuring greater collaboration between Medicaid agencies and SBMs, all of which can serve as the basis for more ambitious coordination efforts between Medicaid and the marketplace.
Streamlined Enrollment Using Tax Data
An easy enrollment system allows Medicaid agencies and SBMs to assess whether a person is eligible for either program based on information from the person's state tax filing or other sources, such as unemployment insurance filings./11
With easy enrollment, people can check a box to authorize state agencies to share relevant information with Medicaid and the marketplace. These agencies use this information to perform a preliminary eligibility assessment and tell people if they are likely to be eligible for either program before they apply. Unlike automatic and streamlined transition strategies, an easy enrollment approach does not involve matching or enrolling people in a health plan. Five SBM states have implemented easy enrollment for marketplace plans, three SBM states plan to implement this policy in 2024, and two states plan to fully implement this policy after transitioning to an SBM./12
Covering Enrollees' Initial Premiums
Paying initial premiums for people who transition from Medicaid to the marketplace reduces a cost barrier that can discourage people from enrolling. It also allows states to implement automatic enrollment without exposing people to unexpected premium costs.
Several states are covering initial premiums:
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Looking Ahead
States only implemented many of these policies recently, so it will take time to evaluate the effectiveness of each approach. But state efforts to improve coordination between Medicaid and marketplace eligibility should serve as test cases for other SBMs as well as the federally run HealthCare.gov marketplace.
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Footnotes:
[1]In addition,
[2] MACPAC, "Transitions Between Medicaid, CHIP, and Exchange Coverage,"
[3] Covered California, "Public Health Emergency &
[4] Maryland Health Connection, "Medicaid to Private Plan Enrollment," visited
[5]
[6]
[7]
[8] HealthSourceRI, "Transitioning from Medicaid to a Qualified Health Plan," visited
[9] Stay Covered RI, "Medicaid Renewals Data Dashboard," updated
[10] "SBMs in Plan Year 2023 that operate an integrated eligibility system for purposes of reporting are:
[11] Maryland Health Benefit Exchange, "Maryland Easy Enrollment Health Insurance Program Advisory Work Group Meeting,"
[12] HealthInsurance.org, "Easy enrollment program," viewed September 18, 2023, https://www.healthinsurance.org/glossary/easy-enrollment-program/.
[13]
[14] Katy Golvala, "Most CT residents enduring Medicaid 'unwinding' keep coverage," CT Mirror,
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Original text here: https://www.cbpp.org/research/health/states-can-improve-transitions-between-medicaid-and-the-marketplace
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