Under health reform, Medicaid will expand in 2014 to cover an additional 16 to 20 million beneficiaries. Due to fluctuations in income, this new population is also likely to “churn” between existing Medicaid programs, the new Medicaid expansion, subsidized exchange qualified health plans, and possibly state-run basic health plans, creating a heightened need for seamless coverage transitions across state health care programs.
This brief, prepared by the Center for Health Care Strategies for the Robert Wood Johnson Foundation’s State Health Reform Assistance Network, draws from current programs that have dealt with this challenge successfully, with the hope that their experience will help guide seamless coverage transitions between Medicaid managed care organizations and qualified health plans in the exchanges. It reviews lessons from: (1) existing exchange programs in Massachusetts; (2) transition coverage policies within Tennessee’s proposed exchange model; and (3) current transition practices between Medicaid managed care organizations and other programs. The brief, which includes a matrix detailing sample contract language related to continuity of care during coverage transitions, is intended to raise considerations for states as they develop coverage approaches between Medicaid and a state or federal exchange.