Medicaid and Marketplace Eligibility Changes Will Occur Often In All States; Policy Options Can Ease Impact

Under the ACA, changes in income and family circumstances are likely to produce frequent transitions in eligibility for Medicaid and health insurance Marketplace coverage for low- and middle-income adults. This report provides state-by-state estimates of potential eligibility changes (“churning”) if all states expanded Medicaid under health reform, and identifies predictors of rates of churning within states. The authors found that, even in states with the least churning, more than 40 percent of adults likely to enroll in Medicaid or subsidized Marketplace coverage would experience a change in eligibility within twelve months. Policy options for states to reduce the frequency and impact of coverage changes include adopting twelve-month continuous eligibility for adults in Medicaid, creating a Basic Health Program, using Medicaid funds to subsidize Marketplace coverage for low-income adults, and encouraging the same health insurers to offer plans in Medicaid and the Marketplaces.