Somebody ought to pass a law against all of these unintended consequences:
In 2014, millions of people are expected to shift between the health exchanges and Medicaid as their income fluctuates. That could be costly for states and insurance companies, and patients could wind up having gaps in coverage or having to switch health plans or doctors.
The process — called “churning” — is common in Medicaid, the state-federal program for the poor and disabled. Typically, people lose Medicaid eligibility after their income spikes temporarily, such as when they get a seasonal job or pick up extra hours at certain times of the year. They re-enroll when their income drops.
Until now, people who churn out of Medicaid because of an income bump often wound up uninsured because they cannot afford private insurance. Starting this month under the Affordable Care Act, many will become eligible for insurance and subsidies through the exchanges.
But experts warn that churning will continue to be a problem as patients bounce between Medicaid and the exchanges. Patients in an exchange plan may end up in a Medicaid managed-care plan run by another company, with different doctors, or vice versa.
“This is a critical issue for the states and the providers. They are worried about patients experiencing gaps in coverage,” said Jenna Stento, a senior manager who tracks the health law at Avalere Health, a consulting firm. “It could be a very significant population that is moving back and forth.”
It’s absolute chaos, and it’s only going to get worse.
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