Continuous Medicaid eligibility supports healthy families, communities

From the This is Medicaid coalition, Mid-Minnesota Legal Aid  When Minnesotans get the health care they need, they can live […]

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From the This is Medicaid coalition, Mid-Minnesota Legal Aid 

When Minnesotans get the health care they need, they can live their lives fully, in the communities they choose, and contribute to building their futures. Minnesota has a strong history of investing in health care and can continue to make the state’s health care system more equitable so that it works for everyone, regardless of income, address, age, disability, race, ethnicity, or gender. 

“Churn” disrupts care. Medicaid churn happens when people are repeatedly dropped from Medical Assistance (MA) due to process and paperwork problems or small eligibility changes, only to re-enroll months later. It is a chronic problem that causes costly disruptions to care for Minnesota patients and the providers and state agencies that serve them. 

During the COVID pandemic, Minnesota complied with federal requirements to keep people enrolled during the public health emergency, thereby reducing the chances for disruptions in coverage. 

Since the end of the public health emergency, states have begun to redetermine eligibility (“unwinding”), and we are seeing a return to churn and a costly spike in the number of Minnesotans losing care and coverage. Over a quarter of disenrollments have been “procedural,” meaning the person was not determined ineligible, they just may not have received their renewal notice or been able to complete the process, and likely do not have another source of coverage. This is a national and a local problem, and while Minnesota DHS is taking many steps to mitigate coverage loss during this moment of transition, we need long term solutions to prevent the destructive, wasteful cycle of churn. 

Minnesota needs continuous MA eligibility for adults to provide stability and security for enrollees and health care providers; to reap the full benefits of continuous eligibility for children by keeping parents covered; and to learn and improve from the eligibility lessons of the pandemic. Once determined eligible for MA, enrollees would be eligible for 12 months, without the threat of losing coverage due to changes such as small fluctuations in income or issues with periodic data matching. Thirty-four states already offer this for children, and five states have continuous eligibility for some or all adults.

New York, New Jersey, and Oregon have 12-month adult CE, Massachusetts covers certain vulnerable adult populations and is awaiting federal approval to include all adults, and Kansas covers adult parents and caregivers. 

Continuous eligibility protects Minnesotans from losing coverage due to system or human error, and encourages confidence in scheduling and keeping medical, dental, and mental health appointments with trusted providers for the whole family 
Continuous eligibility offers a bridge of coverage to adults transitioning to better paying jobs, and stabilizes access to mental health care and critical medications for vulnerable adults. 

Continuous eligibility strengthens health equity — research shows people of color are at greater risk of losing Medicaid coverage for procedural reasons and due to short-term fluctuations in income. 

Continuous eligibility ensures that individuals who are enrolled in Medicaid have uninterrupted continuous coverage. Consistent access to medical care and check-ups improves health outcomes, supports health equity, and lowers administrative burdens on enrollees. The 2022 Minnesota DHS report “Building Racial Equity into the Walls of Minnesota Medicaid” noted that enrollees who had gaps in coverage of more than six months were less likely than those who were continuously enrolled “to have a regular source of care, more likely to forego health care for financial reasons, and more likely to report problems paying medical bills.

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