Want to Keep Medicaid Enrollees?

March 17, 2015 · NCQA

Support the Stabilize Medicaid and CHIP Coverage Act.

NCQA urges you to support legislation ensuring that people covered by Medicaid or the Children’s Health Insurance Program don’t lose coverage.

Enacting this legislation will help prevent avoidable complications, strengthen quality measurement and improvement efforts and, ultimately, reduce costs. It will reduce administrative burdens on plans, providers and patients. It will give people a chance at good health that optimizes their ability to get education, jobs and wages that support private sector coverage.

Many states maintain outdated requirements for frequent re-enrollment in these vital programs to re-verify incomes—a practice that consumers can stumble over, losing coverage because of short-term income fluctuations that make private coverage unaffordable.

The small dollar amounts these policies save are far outweighed by the higher spending required to treat costly complications that could have been avoided with continuous coverage. Coverage disruptions also mean extra administrative costs for states, plans and providers. On average, the costs for 12 months of continuous coverage are 22 percent less per month than for 6 months of coverage, and 42 percent less than for 1 month of coverage.

Frequent coverage disruptions also cripple the ability to measure quality—essential for pay-for-performance, which requires at least 12 months of continuous coverage. When patients drop off after a few months, plans and providers cannot get credit for providing good care and sometimes do not have a high-enough patient base to report.

The quality problems and weak accountability caused by frequent coverage disruptions may lead to poorer health and contribute to commonly overlooked income-related health care disparities. Poorer health limits enrollees’ ability to engage in education and efforts to become gainfully employed and obtain private coverage.

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