How Will Health Reform Affect Churning in States?
- 1. Funded by a grant from the RobertWood Johnson Foundation How will health reform affect churning in states? Brett Fried, MS State Health Research and Policy Interest Group Meeting (SHRP) June 22, 2013
- 2. Acknowledgements • Supported by a grant from the Robert Wood Johnson Foundation to the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota • Co-Author – Julie Sonier, SHADAC 2
- 3. Overview • Background on Churn • Methods • Results • Discussion • Implications • Future Research 3
- 4. Churn: Background What is it? Churning in this presentation is the percent of individuals who are income-eligible for Medicaid at a point in time, but no longer eligible 12 months later Why does it matter? – Can disrupt continuity of care – Can increase administrative costs for plans, providers and government entities – Knowledge about the degree of churn can help states, providers and plans reduce the costs and impacts of churning 4
- 5. Churning for Medicaid Enrollees Eligibility changes due to: • Changes in income • Changes in family size What happens to people who lose Medicaid eligibility? • Uninsured • ESI or Direct Purchase • Post ACA Implementation: Subsidies in the Exchange 5
- 6. Data Source – The SIPP • The Survey of Income and Program Participation (SIPP) is a Census Bureau panel survey that is done in four month waves with each wave split into four groups (rotations) and asked to recall information over four months (reference months) • The purpose of the SIPP is to provide information on income and government program participation • Here we are using reference month April 2010 from wave 6 and April 2011 from wave 9 of the 2008 panel which includes about 90,000 observations • Not designed to be state representative 6
- 7. Analytic Approach • Sample was limited to people who were present in both waves of the survey • Adjusted for attrition using a simple logistic regression • The focus of this research is change in Medicaid eligibility after 12 months as a result of changes in income volatility and family size • State Medicaid eligibility for jobless parents of dependent children and jobless other adults is from Kaiser (2013) survey of Medicaid eligibility • National data but tested weighting to states 7
- 8. RESULTS 8
- 9. Income Distribution by Eligibility Group 22% 22% 26% 26% 20% 19% 41% 42% 44% 44% 40% 41% 36% 37% 30% 31% 40% 40% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 2010 2011 2010 2011 2010 2011 0-138% FPG 139-400% FPG 401%+ FPG 9 Nonelderly Adults Parents Childless Adults
- 10. Starting at 0-138% FPG: Where are they after 12 months? 68% 73% 64% 27% 24% 29% 5% 3% 7% 0% 10% 20% 30% 40% 50% 60% 70% 80% Nonelderly Adults Parents Childless Adults 0-138% FPG 139-400% FPG 401%+ FPG 10
- 11. Starting at 139-400% FPG: Where are they after 12 months? 13% 14% 13% 72% 73% 71% 15% 13% 16% 0% 10% 20% 30% 40% 50% 60% 70% 80% Nonelderly Adults Parents Childless Adults 0-138% FPG 139-400% FPG 401%+ FPG 11
- 12. Starting at 401%+ FPG: Where are they after 12 months? 3% 3% 3% 16% 16% 16% 81% 81% 81% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Nonelderly Adults Parents Childless Adults 0-138% FPG 139-400% FPG 401%+ FPG 12
- 13. As the Medicaid Eligibility Threshold increases, “churn” decreases for parents and childless adults 62% 60% 57% 55% 52% 50% 45% 42% 38% 36% 33% 32% 29% 27% 57% 56% 55% 54% 53% 52% 49% 47% 45% 43% 41% 39% 37% 36% 0% 10% 20% 30% 40% 50% 60% 70% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 110% 120% 130% 138% Percentchurnafter12months Medicaid EligibilityThreshold Parents Childless Adults 13
- 14. Percent of parents who are income eligible for Medicaid but are ineligible after 12 months 14
- 15. Reduction in “churn” as a result of change from state to ACA Medicaid eligibility threshold: Parents 15
- 16. Discussion Other reasons why people “churn” into or out of Medicaid: • Changes in family status • Changes in assets • Changes to program administration • Change in awareness or ability to renew coverage The ACA will reduce some of this churn because of the following: • Streamlined application process • Requiring the use of existing state information • Increased awareness of renewal process 16
- 17. Implications For every increase in the Medicaid eligibility threshold by 10 percentage points, “churn” decreases on average by 3 percentage points for parents and on average by about 1.5 percentage points for childless adults. Consequently, states that have a current eligibility threshold for parents and/or childless adults that is less than 138% of poverty should see a decrease in churn (as defined here) if they choose the ACA Medicaid expansion. 17
- 18. Future Research • Estimate the characteristics of people that churn at the state level • Estimate churning over different time periods • Estimate churning into and out of subsidies in the exchange. 18
- 19. Sign up to receive our newsletter and updates at www.shadac.org @shadac Brett Fried Senior Research Fellow 612-624-1406 bfried@umn.edu