Healthaffairs.org – The termination of Medicaid and Children’s Health Insurance Program (CHIP) coverage due to short-term income changes or frequent reapplication requirements increases overall health care costs and negatively affects quality of care and quality measurement and improvement efforts. This may have a significant yet commonly overlooked impact on income-related health care disparities. By requiring at least twelve months of continuous coverage, we could prevent avoidable complications, reduce administrative burden, improve quality measurement and improvements efforts, and ultimately, reduce costs.
Current Medicaid Coverage Costs
One year of continuous adult Medicaid coverage costs, on average, 22 percent less per month than six months of coverage, and 42 percent less than just one month of coverage. That is because people who lose coverage have more emergency room visits, hospital admissions, and preventable problems such as the onset of asthma and diabetes; they also have more problems that could have been managed with ambulatory care and lower rates of cancer screening and early detection. Current re-enrollment requirements also contribute to additional administrative costs that will increase as people toggle back and forth between Medicaid/CHIP and the individual health insurance exchanges.
Less than twelve months of coverage also directly harms quality measurement and improvement efforts. Because accurate measurement requires at least twelve months of coverage, those with shorter coverage periods are excluded from performance evaluation. Most Healthcare Effectiveness Data & Information Set (HEDIS is a registered trademark of NCQA) measures, for example, require evaluation of at least twelve months of claims or record reviews to ascertain whether appropriate services were provided in a timely manner. As a result, plans and providers may not have enough people on which to report and do not get credit for high quality.
Quality Improvement Efforts
By addressing problems early to avoid costly complications, high-quality care reduces costs. Studies have shown that Medicaid quality improvement efforts include the following benefits:
- More timely prenatal care and reduced neonatal intensive care unit admissions
- Improved anti-psychotic medical adherence and lower inpatient mental health costs
- Increased well-child visit schedule adherence in the first two years of life and therefore less avoidable hospitalizations
- Earlier preventive care and lower children’s dental costs
- Reduced emergency room use and hospital admissions for asthmatic children
- Reduced emergency room use and hospital admissions for high-risk patients
But even though many people remain eligible for Medicaid or CHIP, millions are losing coverage each year. Currently, Medicaid enrollees average four months or less of coverage per year, while “there is a 13 million person gap between the number of people who are ever covered in the year and the number covered at a given time.” This is a result of many states’ requirements to repeatedly document eligibility as often as every six months or less.
‘Churning’ And The Importance Of Policy
This “churning” is becoming even more problematic. In a recent Web First from Health Affairs (to be published in the upcoming April issue), “Medicaid And Marketplace Eligibility Changes Will Occur Often In All States; Policy Options Can Ease Impact,” authors Benjamin Sommers, John Graves, Katherine Swartz, and Sara Rosenbaum find 40 percent of adults likely to enroll in Medicaid or state Health Insurance Exchange coverage will experience a change in eligibility within twelve months.
These dubious red-tape rules are intended to save money, but they in fact end up costing more in administration burden and increased health care needs. People lose coverage due to short-term income fluctuations that do little to bring private coverage within reach. Such churning remains uncommon in private sector coverage, where people generally remain enrolled in plans unless they change jobs or deliberately change coverage. Medicaid and CHIP policies that cause churning may also contribute to income-related health care disparities, which are a priority in Principles for the National Quality Strategy.
Recent legislation could provide a solution. Congressmen Gene Green and Joe Barton of Texas are cosponsoring the bipartisan Stabilize Medicaid & CHIP Coverage Act (H.R. 1698), requiring twelve-month coverage. Senator Jay Rockefeller of West Virginia is sponsoring the more comprehensive Medicaid & CHIP Continuous Quality Act (S. 1980) that requires twelve-month continuous coverage and standardized quality measurement in both managed care and fee-for-service. It also gives bonuses to states that improve quality. Requiring quality measurement in fee-for-service, as is now required for health plans, would further provide a better picture of quality, help identify gaps and make needed improvements in care.
Sumber: http://healthaffairs.org/blog/2014/03/13/
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