041 - Healthcare Coverage Transitions in the Individual and Medicaid Expansion MarketsIndividual and Medicaid Expansion Markets The Affordable Care Act (ACA) extended coverage to millions of low-income ... out of coverage, or how those transitions affect care utilization and spending. Better insight into these ...
Description: The Affordable Care Act (ACA) extended coverage to millions of low-income consumers through Medicaid expansion and increased enrollment in the Individual market—the former targets adults with incomes below 138% of the federal poverty line (FPL), and the latter helps cover those above that line. Even though incomes for many consumers are known to rise above or fall below the 138% FPL threshold with some frequency, comparatively little is known about how Individual market enrollees and ACA Medicaid expansion enrollees transition in and out of coverage, or how those transitions affect care utilization and spending. Better insight into these issues could help both private- and public-sector stakeholders develop better strategies for helping consumers maintain coverage, as well as better manage healthcare costs and improve outcomes.This session will explore insights related to coverage transitions in the Individual and Medicaid expansion markets, including:1. Member coverage changes (lapses and re-enrollment) in the Individual and Medicaid expansion markets2. Coverage transitions between Individual and Medicaid markets3. Member cost and utilization profiles based on pattern of coverage changes, and implications of churn on pricing and forecasting4. How stakeholders, including payers and government agencies, can respond to the coverage patterns identifiedHide
- Authors: Ernest Jaramillo, Anna Leigh Buchholtz, Nina Jacobi, Yuxiao Zhao, Andy Allison
- Date: Jul 2019
- Competency: External Forces & Industry Knowledge
- Topics: Health & Disability>Health insurance; Public Policy