The Oregon House has unanimously passed a bill that tries to take a step towards limiting Medicaid "churn" -- a problem some think may grow under expanded Medicaid and insurance exchange coverage, with individual and family incomes fluctuating in an uncertain economy.
The bill directs the Oregon Health Authority and the insurance exchange Cover Oregon to find potential long-term fixes, while also ensuring that qualified health plans offer similar networks to the Oregon Health Plan, the state Medicaid program, so individuals and families can keep their primary care doctors when switching between the two programs.
The Oregon Health Authority, which administers Medicaid, has estimated that by 2016 as many as 60,000 Oregonians could be shifting back and forth between eligibility for Medicaid and for premium assistance under Cover Oregon.
[See also: Skeptically watching Oregon's ACO experiment]
The bill also requires the Oregon Health Authority and Cover Oregon to issue quarterly progress reports on their efforts to coordinate eligibility determination and enrollment.
"Churn" has vexed the Medicaid program since its inception, and the Affordable Care Act, despite its expansion of Medicaid, could exacerbate the problem and potentially discourage people from getting insurance.
Health policy researchers Benjamin Sommers and Sara Rosenbaum estimated in a 2011 Health Affairs study that more than 35 percent of all adults with family incomes below 200 percent of the federal poverty level could see a shift in eligibility from Medicaid to an insurance exchange, or the reverse, within a six-month time frame.
Over the course of year, they estimated as many as 28 million Americans could see their eligibility change because of fluctuating incomes.
One solution they recommended -- slightly similar to the Oregon bill's directives -- would be "dually certifying" some plans to serve both Medicaid and exchange enrollees, with beneficiary costs changing with their incomes, rather than their eligibility for a certain plan.