Advocates seek sponsor for bill that would keep people on Medicaid longer

Advocates for low-income Americans are looking for a lawmaker to champion draft legislation requiring states to keep Medicaid-eligible people on the public program for 12 months at a time.

The advocates are worried about people entering and dropping out of Medicaid several times a year as their income changes. The practice, known as churning, has been shown to reduce access to screening for diseases such as breast cancer while increasing hospitalization rates.

The insurance disruption also creates administrative and processing costs for states and the federal government as people re-enroll multiple times. Healthcare reform could make the situation even worse, because people will shift from Medicaid to the state health insurance exchanges. 

Within six months of the exchanges starting to operate in 2014, a new study in Health Affairs indicates, 35 percent of all adults with family incomes below 200 percent of the federal poverty level are expected to experience a shift in eligibility from Medicaid to the exchanges, or vice versa.

The proposal is modeled after recommendations from the Association for Community Affiliated Plans. It would force states to keep beneficiaries on Medicaid for 12 months at a time while providing $500 million in grants to incentivize states to make enrollment easier, by getting rid of face-to-face enrollment, for example.

The proposal also requires reporting of quality measures for enrollees in Medicaid fee-for-service and Primary Care Case Management. Under current law, only managed care organizations have to report on the quality of care they provide.

Several groups support the proposal, among them First Focus, Families USA, the National Association of Public Hospitals and Health Systems and the National Committee for Quality Assurance. Rep. Niki Tsongas (D-Mass.) has been mentioned as having concerns with Medicaid churning, but she has not to date signed on to the draft legislation.