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Churning in Medicaid managed care and its effect on accountability
Insights
Medicaid churning impacts child immunization reporting, as many children don't meet continuous enrollment rules. This affects accountability for managed care, potentially leaving vulnerable children without needed services.
Area of Science:
- Public Health
- Health Services Research
- Pediatrics
Background:
- Medicaid managed care accountability systems often require one-year continuous enrollment.
- Childhood immunization coverage is a key metric within these systems.
- Frequent enrollment changes, or 'churning,' may exclude children from accountability measures.
Discussion:
- This study investigated how Medicaid churning affects the measurement of childhood immunization coverage rates.
- Data from administrative databases of the Centers for Medicare and Medicaid Services (CMS) and 12 states were analyzed.
- The analysis focused on children enrolled in Medicaid managed care plans.
Key Insights:
- Only 39% of children in a specific managed care plan met the continuous enrollment requirement on average across 12 states.
- However, 78% of children had continuous Medicaid enrollment for 12 months, even if not in the same plan.
- Significant state-level variation exists in both plan-specific and overall Medicaid enrollment continuity.
Outlook:
- Policies contributing to Medicaid churning may inadvertently exclude vulnerable children from quality assurance systems.
- Revising accountability metrics to account for churning could improve access to care for continuously enrolled children.
- Further research is needed to understand the full impact of churning on healthcare access and outcomes for children.
Abstract:
There is concern that churning in Medicaid excludes children from the accountability system for managed care because they may not meet the one-year continuous enrollment requirement. This study explores the effect of churning in measuring childhood immunization coverage rates under the current accountability system. Data were collected from administrative databases at the Centers for Medicaid and Medicare Services and 12 states with high Medicaid managed care penetration. On average in the 12 states only 39% of the children enrolled in one specific managed care plan met the continuous enrollment requirement. However, Centers for Medicaid and Medicare Services data showed that 78% of children were enrolled in Medicaid (but not the same plan) continuously for 12 months. Both plan-specific rates and overall Medicaid rates varied greatly across the states. Policies that result in churning mean that many vulnerable children fall outside of the accountability structure intended to assure that they receive necessary services.
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