PHE- MACPAC: Only 3% gained exchange coverage after leaving Medicaid

MM Curator summary

[MM Curator Summary]: Pivoting to the exchanges during the wind-down may not be a great plan.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.



A paltry 3% of people got Affordable Care Act exchange coverage within a year after leaving Medicaid or the Children’s Health Insurance Program, a new study found. 

The study published last month by the Medicaid and CHIP Payment and Access Commission (MACPAC) comes as states are pondering how to transition scores of people from Medicaid to the exchanges once pandemic emergencies unwind. 

“We found that most individuals who moved from Medicaid to the exchange had a gap in coverage; these gaps were longer for racial and ethnic minorities,” wrote MACPAC, a panel that advises Congress on Medicaid and CHIP issues.

Researchers looked at enrollment data on CHIP, Medicaid and the ACA marketplaces from 2017 through 2019.

“Overall, we found that most beneficiaries who disenrolled from Medicaid or CHIP in 2018 returned to the same program within 12 months (a phenomenon referred to as churn) or did not enroll in another insurance affordability program,” the study said.

It found that 3% of beneficiaries who dropped off Medicaid or CHIP in 2018 got coverage on the exchanges in 12 months. Of the people who got ACA coverage, 3.9% were enrolled in Medicaid and 3.3% in CHIP. A beneficiary who moved from Medicaid or CHIP to ACA was much more likely to have a gap in their coverage. 

“For example, less than one quarter of children moving between Medicaid and CHIP experienced a gap in coverage, but more than 70% of adults and children moving from Medicaid to exchange coverage had gaps,” the study stated. 

On average the coverage gap from going to Medicaid or CHIP was three months, but was longer for Black, Hispanic and Indian Alaskan Native beneficiaries, MACPAC said. Non-Hispanic adults, for example, had a coverage gap of 73 days while Black and non-Hispanic adults didn’t have coverage for 105 days. 

The study results take on pressing relevance as states are preparing for the COVID-19 public health emergency to expire sometime this year or in 2023. 

At the start of the pandemic, Congress gave states the chance to get a 6.2% increase in their federal matching rate for Medicaid. However, states that took the extra funds were prohibited from dropping anyone from Medicaid or CHIP coverage for the duration of the PHE. 

The Department of Health and Human Services has extended the PHE through October. A report from Politico said that the PHE will be extended again for another 90 days, and HHS has promised stakeholders a 60-day heads up for when the PHE won’t be extended again.

States and the federal government have been preparing for the eventual expiration of the emergency, including how to handle coverage for those who are no longer eligible for Medicaid or CHIP. All states have 14 months after the PHE ends to redetermine Medicaid eligibility.

“Although many individuals who lose Medicaid coverage are expected to be potentially eligible for exchange coverage, the analyses in this memo suggest that many eligible individuals may not enroll,” the study said. “Administratively, states are required to transfer applications from Medicaid to the exchange if individuals are potentially eligible, but in practice, these account transfers do not always work as intended.”

As the PHE expiration looms, the Centers for Medicare and Medicaid Services has given states guidance on the unwinding. The agency has helped states to improve notices and is aiding community-based organizations on gathering the additional information needed for completing an exchange application. 

Congress may be helping with the transition. MACPAC cited potentially higher premiums on the exchanges as a barrier to getting coverage for those who transition from Medicaid or CHIP.

However, the Senate passed the Inflation Reduction Act on Sunday, which extends boosted subsidies on the exchanges through 2025. The House is expected to vote on Friday on the package, which also includes drug pricing reforms. 


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