Understanding Medicaid Churn
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As the nation’s largest insurance provider, currently serving over 80 million individuals, increasing coverage continuity among Medicaid beneficiaries is crucial to improving health equity and economic mobility among low-income populations. Medicaid churn — the cycling of individuals on and off Medicaid coverage — is a common and persistent 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 approximately 25 percent of Medicaid beneficiaries experience at least one coverage change within a year.
Federal response to the COVID-19 pandemic has temporarily eliminated Medicaid churn since under the Families First Coronavirus Response Act (FFCRA) states are prevented from disenrolling Medicaid beneficiaries. The protection the FFCRA affords, however, disappears once the federal public health emergency declaration ends, putting a significant number of Medicaid beneficiaries at risk for disenrollment and resulting in the resumption of churn within the Medicaid population.
Investments in efforts that reduce Medicaid churn can result in more efficient Medicaid agencies and administrative cost savings, reducing staff workload and allowing staff and resources to be dedicated to other priorities. With support from the Robert Wood Johnson Foundation, Benefits Data Trust (BDT) has developed this “Medicaid Churn Toolkit” to guide Medicaid agencies and their partners in the design and implementation of efforts to reduce churn as they plan for the resumption of normal eligibility and enrollment actions (including renewals, redeterminations, and post-enrollment verifications) and beyond.
The “Medicaid Churn Toolkit” provides step-by-step guidance and templates to facilitate goal setting, collaborative planning and execution and will help users:
Understand what Medicaid churn is and its impact on the healthcare delivery system including the Medicaid agency, providers, payers and Medicaid beneficiaries
Learn how Medicaid churn can be measured including what data sources can be used to calculate churn
Evaluate the current policy and practice landscape to identify opportunities to establish or advance policies and processes that reduce Medicaid churn
Understand how various types of stakeholders (e.g., managed care organizations, foundations, researchers, advocates) can bring valuable skills and resources to a proposed initiative and develop a plan for external stakeholder engagement
Assess how the impact of churn can be measured by gathering information about available data sources, and how data are collected, stored, analyzed, and reported
Develop an informed action plan with next steps for implementing proposed churn solutions
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Each tool within the toolkit can be used as an independent resource and includes detailed instructions for completion including suggestions for the resources needed for completion. The resources in the toolkit include:
Tool: Complete Readiness Assessment
Determine if this is a good fit for your state right now. Assess Leadership Awareness & Overall Motivation for Change and General Capacity & Resource Availability.
Tool: Set Goals
Establish SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) goals for addressing Medicaid churn.
Tool: Build the Core Churn Team
Develop a plan for how the team operates — i.e. how team will review tools, data, practices, etc. and move toward implementation of the action plan.
Tool: Engage External Stakeholders
Identify who needs to be part of the process based on knowledge/expertise & capacity. Identify opportunities for engagement & establish and implement a strategy for engagement.
Tool: Review Current Landscape
Planning Worksheet 1: Understand how data to measure the burden of churn and its impact are collected, stored, analyzed, and reported.
Planning Worksheet 2: Evaluate the impact of current policies and processes on Medicaid churn.
Tool: Complete Prioritization Tool & Action Plan
Determine what policy and process solutions are feasible by analyzing the risk, value, cost and effort of implementation and establish action steps for implementing proposed policy & process changes.
Implement policy and process solutions identified in your state’s Medicaid Churn Action Plan.
BDT helped 16 states streamline benefits access in 2020 and stands ready to assist states in using this toolkit to reduce Medicaid churn and prepare for the end of the COVID-19 public health emergency. We are also striving to make this toolkit a dynamic resource and would greatly value your feedback on ways in which we can make this a more useful product. We would like to hear your thoughts on what you did or didn’t like, what can be improved, and what’s missing.
For questions about this toolkit, comments, suggestions, or technical assistance requests please contact Benefits Data Trust at firstname.lastname@example.org.
Support for this project was made possible by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.