churn continuous eligibility and medicaid the safety net health plan perspective
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Churn, Continuous Eligibility, and Medicaid: the Safety Net Health Plan Perspective. Georganne Chapin President & CEO Hudson Health Plan Hudson Center for Health Equity & Quality Tarrytown, NY   gchapin@hudsonhealthplan.org July 10, 2009. Overview. An Illustration of the Problem

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churn continuous eligibility and medicaid the safety net health plan perspective

Churn, Continuous Eligibility, and Medicaid: the Safety Net Health Plan Perspective

Georganne Chapin

President & CEO

Hudson Health Plan

Hudson Center for Health Equity & Quality

Tarrytown, NY  

gchapin@hudsonhealthplan.org

July 10, 2009

overview
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
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
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
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
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
Solutions: Safety Net Health Plan Action Steps
  • Hudson Health has actively worked toward increasing Medicaid continuous eligibility:
    • At the plan-level:
      • Educating members about renewal requirements
      • Streamlined renewal programs
      • Hcheq: FEEA & EnrollNY
    • At the national policy level:
      • Developing Medicaid continuous eligibility policy with ACAP & GW
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