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Stability and Churning in Medi-Cal and Healthy Families

Stability and Churning in Medi-Cal and Healthy Families. Gerry Fairbrother, PhD Joseph Schuchter, MPH. Presented at California State Legislature Sacramento April 29, 2008. Studies have shown that children with stable coverage

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Stability and Churning in Medi-Cal and Healthy Families

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  1. Stability and Churning in Medi-Cal and Healthy Families Gerry Fairbrother, PhD Joseph Schuchter, MPH Presented at California State Legislature Sacramento April 29, 2008

  2. Studies have shown that children with stable coverage More likely to have a usual source of care – and to use it for most care Less likely to have unmet needs Less likely to experience delays in care Why is Stability Important?

  3. Stable is needed to manage care. Health Plans need time to: Monitor care Institute corrective action, if needed Stable promotes attachment to a regular provider and a medical home Why is Stability Important?

  4. Followed newly-enrolled children in Medi-Cal and Healthy Families to see patterns of enrollment Examined cost after a gap In this study we:

  5. Retention is Poor in both Medi-Cal and Healthy Families

  6. Different Eligibility Groupings have Different Patterns

  7. Healthy Families Shows Sharp Drop-Off at Renewal

  8. One Child in Three Back on Medi-Cal in a Year Children continue to come back on the program even after a year. After three years half to two-thirds are back on.

  9. Two uninsured children in three are eligible for coverage 42% of uninsured, eligible children had been enrolled in Medicaid in the prior year Therefore, states could reduce uninsured by 42% by just retaining eligible children National data shows children are still eligible Somers BD. Why millions of children eligible for Medicaid and SCHIP are uninsured: poor retention vs. poor take-up. Health Affairs 2007;26(5):w560-67.

  10. COSTS OF CHURNING

  11. Medical Costs are Substantial After a Gap Gap>= 3 months (n=164,520)

  12. Costs are Higher After 6 mo Gap>= 6 months (n=83,058)

  13. And Highest After 12 mo Gap>= 12 months (n=23,492)

  14. There are also administrative costs

  15. Levelof Churning Varies N=319,636 N=1,838,672 N=525,057 N=414,868 N=90,800 Data Source: State Medicaid Enrollment Files. Data includes children ages 5-18.

  16. Features of the Medicaid Program that may Affect Enrollment/Renewal Donna Cohen Ross and Laura Cox. Beneath the Surface: Barriers threaten to slow progress on expanding health coverage of children and families. Kaiser Family Foundation. October 2004. (Based on data as of July 2004)

  17. Only half newly-enrolled children “survive” after 21 months Sharpest drop occurs at the 12-month renewal period Drop is more gradual for children in families receiving cash assistance or food stamps Conclusions

  18. More frequent renewals will hit hardest children in 1931(B) and percentage programs These families are teetering on the brink of poverty and may need to support health care provides Costs are higher after a gap; the longer the gap the higher the cost when children return to coverage Conclusions

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