BDT’s Learning Collaborative: Helping States Stabilize Medicaid Coverage

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BDT, with support from the Robert Wood Johnson Foundation, is hosting a 12-month learning collaborative – a unique opportunity for six state Medicaid agencies to receive individually-tailored technical assistance to develop and advance policies and practices that reduce the cycling of individuals on and off Medicaid coverage, also known as Medicaid churn.

Project Description

As the nation’s largest insurance provider, Medicaid plays a critical role in protecting the health and well-being of millions of Americans nationwide. As a joint federal-state program, states are required to renew the eligibility of Medicaid enrollees once every 12 months. However, the Families First Coronavirus Response Act (FFCRA) established a continuous coverage requirement that temporarily halted typical renewal processes, eliminating most churn. When the federal public health emergency (PHE) declaration ends, millions of adults and children will be at risk of losing health coverage.


Medicaid churn is a common problem within the healthcare delivery system, increasing healthcare and administrative costs and resulting in poor outcomes due to disruptions in care. Research has shown that prior to the COVID-19 pandemic, approximately 25 percent of Medicaid beneficiaries experienced at least one coverage change within a year. This persistent issue disproportionally affects vulnerable populations and increasing coverage continuity among Medicaid beneficiaries is crucial to improving health equity and economic mobility

There are several policy and process options states can pursue to help reduce the likelihood of churn and mitigate its impact on health and cost outcomes. Additionally, the federal government has provided states with some temporary flexibilities that can further protect coverage continuity at the end of the public health emergency declaration. By taking a proactive approach now, states can protect coverage for eligible Medicaid beneficiaries, reducing the likelihood of increases in healthcare and administrative costs and poor health outcomes due to disruptions in care. 

Project Activities

BDT is providing each of the six states with 12 months of tailored technical assistance, including:

  • Monthly, one-hour one-on-one state technical assistance calls, designed to meet states where they are and address specific needs to advance Medicaid churn reduction goals;  
  • Two virtual or in-person convenings;  
  • One site visit or virtual working session per state;  
  • Quarterly peer calls to share state learnings, best practices, and to foster cross-state collaboration; and  
  • Ad hoc webinars with national and state-specific subject matter experts focused on sharing strategies to address common churn reduction challenges.  

Learn more about the Collaborative Participants