Tennessee health officials have drafted a plan aimed at helping low income families maintain a continuity of care with health coverage shared through Medicaid and partial insurance.
The problem of annually varying Medicaid eligibility, known as "churn," could become more complex with state exchanges. In Tennessee, health officials say that low income families at times have several different insurance providers, between Medicaid, CHIP and private insurance. In the next few years subsidized insurance bought in exchanges will be another factor.
The Tennessee commerce and insurance department's exchange planning initiative calls the plan "one family, one card." The state would ask managed care companies to offer an insurance plan covering 70 percent of healthcare costs, available only through the state-based exchange and to parents in nuclear families with at least one member on Medicaid. Families would have one insurance card accepted by providers that accept Medicaid, and they could continue coverage as long as one family member remains eligible.
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About 24 percent of Tennesseans use Medicaid, almost all in the state's TennCare managed care program. Brian Haile, director of Tennessee's exchange initiative, told the National Academy for State Health Policy conference in Baltimore recently that the aim is to "minimize the times people get a letter from us (saying their eligibility has changed) and maximize their focus on keeping health care coverage and staying healthy," as the Pew Center on the State's Stateline wrote.
The Urban Institute has estimated that about 30 percent of people in the ACA's main affordability programs will have incomes that vary enough year to year to change their Medicaid eligibility, which in 2014 will be 133 percent of the federal poverty level, about $23,000 for a family of four.
The problem of churn is one that's going to have to be managed, along with administrative and legal costs associated with Medicaid expansion and ACA implementation, Joan Henneberry, principal at Health Management Associates in Denver and a former Colorado exchange planning director, told Government Health IT.
After federal funding declines, Hennebery said, states are going to have to find savings, and one ripe area is reducing churn and its administrative costs by integrating exchange and Medicaid eligibility systems.
Other states are proposing various eligibility "bridge" options. Tennessee's "one family, one card" plan is part of the state's ACA contingency plan. The state government is undecided on Medicaid expansion and on the HIX, although the governor has asked the legislature to grant $726,000 in ACA planning to the Tennessee Healthcare and Finance Administration, and to receive as much in matching federal HIX grants.