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Implications of eligibility category churn for pediatric payment in Medicaid
Deena J Chisolm1, Sean P Gleeson, Kelly J Kelleher
1Department of Pediatrics, The Ohio State University College of Medicine, 700 Children's Drive, RM FB3322, Columbus, OH 43205.
Insights
Pediatric Medicaid eligibility churn is common, with over 20% of children switching categories. This instability impacts average capitation rates but does not affect overall healthcare utilization for children in Ohio.
Area of Science:
- Pediatric Health Services Research
- Health Policy Analysis
- Medicaid Program Evaluation
Background:
- Medicaid eligibility categories, such as Aged, Blind, and Disabled (ABD) and Healthy Start, have distinct criteria.
- Policy changes can influence beneficiary transitions between these categories.
- Understanding churn is crucial for financial and utilization analyses within Medicaid programs.
Purpose of the Study:
- To quantify the extent of Medicaid eligibility category churn in a pediatric population.
- To investigate the implications of this churn on financial metrics, specifically capitation rates.
- To examine the relationship between eligibility category switching and healthcare utilization.
Main Methods:
- Analysis of Ohio Medicaid claims data from July 2013 to June 2015.
- Calculation of an effective capitation rate to assess financial impact.
- Examination of demographic factors associated with eligibility category switching.
Main Results:
- Over 20% of children experienced at least one exit from ABD-based Medicaid eligibility.
- Eligibility switching was associated with younger age and rural residency.
- No significant association was found between switching and healthcare service utilization.
Conclusions:
- Medicaid eligibility category switching is a frequent occurrence among children.
- While churn affects average capitation rates, it does not appear to alter health service use.
- These findings have implications for Medicaid program financial modeling and policy adjustments.
Objectives:
To describe the extent and implications of "churn" between different Medicaid eligibility classifications in a pediatric population: (1) aged, blind, and disabled (ABD) Medicaid eligibility, determined by disability status and family income; and (2) Healthy Start Medicaid eligibility, determined by family income alone.
Study Design:
As a result of a 2013 policy change, children with ABD eligibility transitioned from fee-for-service to capitated care. We used Ohio Medicaid claims data from July 2013 through June 2015 to explore the relationships among instability in eligibility category, demographics, and utilization.
Methods:
To examine the potential financial effect of categorical churn, an effective capitation rate was created to capture the proportion of the maximum potential capitation rate that was realized.
Results:
More than 20% of children exited ABD-based eligibility at least once. Switching was associated with younger age and rural residence and was not associated with healthcare use.
Conclusions:
Switching between eligibility categories is common and affects average capitation but not health service use.
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