269056 Addressing "churn" in state health insurance programs

Monday, October 29, 2012 : 11:30 AM - 11:50 AM

Ronald D. Deprez, PhD MPH , University of New England, Center for Community and Public Health, Portland, ME
Carry Buterbaugh, MA , Center for Community and Public Health, University of New England, Portland, ME
Hank Stabler, MPH , Center for Community and Public Health, University of New England, Portland, ME
Churn (recipient turnover in health insurance programs) has long plagued state Medicaid/CHIP programs and state initiated insurance programs. Churn increases administrative costs and often leaves people without coverage. Moreover, health exchanges and expanded Medicaid coverage will intensify the problem, where changes in reported income will result in changes in coverage. Policies addressing churn rates show mixed results. This study identified policies that could potentially reduce churn for federally mandated state insurance exchanges. Experiences from states suggest that a commitment to maximizing enrollment by streamlining enrollment and reenrollment processes reduces churn.

Methods: The study was conducted through 1) a comprehensive literature review—published and unpublished papers, reports, etc., 2) interviews with state officials and 3) an analysis of enrollment data from Vermont's Catamount Health insurance program.

Results: Several policies to control churn rates were identified from the research; two in particular were identified as most important for states' in reducing churn and the negative effects associated with churning in health insurance exchanges. They are: 1. Improve the process for recertifying enrollees: States need to update their systems for renewing enrollees; most recertification processes are characterized as being cumbersome and confusing for many enrollees, as well as too reliant on paper forms. Upgrading the system by adopting improved renewal processes will be an important policy for states' to consider and may lower churn rates among those who drop off coverage due to issues related to the renewal process. For example such processes include: o Ex parte renewal o Off-cycle renewal o Recertifying enrollees over the telephone or online o Passive renewal o Proactive follow-up States that stood out as having implemented successful strategies aimed at streamlining reenrollment in programs include Louisiana and Wisconsin, which have in turn minimized churn rates and maximized enrollment among eligible children for their respective Medicaid/CHIP programs. These policies should be expanded to maximize enrollment among eligible adults. 2. Standardizing the benefit packages between plans offered on the Exchange and with Medicaid: With the introduction of publicly-subsidized plans sold on the Exchanges – whose subsidies are sensitive to income - churning between public programs will undoubtedly increase, especially as Medicaid eligibility is also expanded. Unless efforts are made to standardize, as much as possible, the benefits that enrollees have will change each time their income changes.

Learning Areas:
Administration, management, leadership
Program planning
Public health administration or related administration
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
1. To describe the prevalence of "churn" in state health insurance programs 2. To describe the impact of churn on program administration and coverage interuption. 3. To identify policies that mitigate the prevalence and effects of churn.

Keywords: Access, Health Insurance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Director of the UNE Center for Community and Public Health, Dr. Deprez research, teaching and consultation work focus on the design and evaluation of health care programs and policies, health system innovations and health improvement strategies in particular for prevention and management of chronic health conditions. He also teaches the core Health Policy and Management course in UNE’s graduate Masters in Public Health degree program.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.