Continuous Medicaid Eligibility May Benefit Adults
1. FIRM FOOTING
VIEWS & ANALYSIS FROM OUR EXPERTS
Home ∠ Continuous Medicaid Eligibility for Newly Eligible Adults: The Next Big Thing?
Continuous Medicaid Eligibility for Newly Eligible
Adults: The Next Big Thing?
In May 2013, CMS released guidance on a series of targeted enrollment strategies to
streamline Medicaid enrollment and reduce the administrative burden of expanding
Medicaid. Of the five strategies suggested by CMS, only one, continuous eligibility for
newly eligible adults, was not implemented by any of the state Medicaid agencies. The
continuous eligibility option would allow states to provide newly eligible adults with a full
twelve months of Medicaid coverage, ignoring changes in household composition and
income during those twelve months that would normally result in the beneficiaries losing
their coverage. Now that states are beginning to have a better idea about the size of their
Medicaid-eligible adult populations, they may wish to revisit this potentially transformative
policy initiative.
Continuous eligibility is not a new idea. States have had the option to provide continuous
Medicaid eligibility to children since 1997; as of January 2013, 23 states have
implemented continuous eligibility for children in their Medicaid and/or Children’s Health
Insurance Programs (CHIP).
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2. Potential benefits of continuous eligibility
The opportunity to provide continuous eligibility for adults creates potential new benefits
for both states and beneficiaries, many of which build on those offered by continuous
eligibility for children. Consider the following:
Coordination of care: Often the provider networks of Medicaid and private insurance
companies do not match up one to one, which can cause frustration for Medicaid
recipients who lose coverage and find that they need to locate a new doctor.
Continuous eligibility helps minimize the number of doctor changes people will need.
Reduced churn: Continuous eligibility reduces the potential for churn, where
changes to household income or other factors cause members to fluctuate between
being eligible and ineligible for Medicaid.
Reduced administrative oversight: State eligibility workers no longer need to monitor
changes in circumstance that may impact eligibility, eliminating a potentially time-
consuming process.
Facing the hurdles
Despite the potential benefits, the data shows that states have been hesitant to
implement continuous eligibility for adults. We see several potential reasons for this
reluctance:
Federal match: While many of these adults are newly eligible, CMS has indicated
that the 100% federal match is not available. According to an Aging and Disability
Resource Center (ADRC) Technical Assistance Exchange newsletter from February,
2014, States would only be able to claim 97.4% of member months for continuously
eligible adults at the enhanced match. The remaining 2.6% of member months would
be claimed at the traditional match rate.
Paperwork: Implementation requires completion of an 1115 waiver, which can be
burdensome on state teams that are already stretched thin.
Public perception: States may find it difficult to publicly justify continuing to provide
Medicaid to individuals who have had significant increases in income.
Benefits can outweigh the challenges
Continuous eligibility is not without challenges, but the potential benefits through
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3. Jamie
Brennan
jbrennan@berrydunn.com
improved efficiency and consistency of care are significant. Stay tuned as BerryDunn
presents a more detailed article on continuous eligibility in the coming months.
Editor’s note: This blog was co-written by Jamie Brennan and Justin Davis.
Topics: Management Consulting & Strategy, MESC, Medicaid eligibility, CMS, Medicaid, Medicaid
Enterprise Systems Conference, MESC2014, Affordable Care Act, Health and Human Services
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4. Submit Comment
Written by Jamie Brennan
Jamie Brennan is a Senior Consultant in BerryDunn’s Government Consulting
Group. He has nine years of experience working with state and federal
government agencies, and is the lead in BerryDunn’s Medicaid Innovation and
Healthcare Transformation Practice. Prior to joining BerryDunn, Jamie worked as
a Staff Assistant to US Senator Susan Collins and as an Assistant to the Principal
Examiner for the State of Maine Bureau of Consumer Credit Protection.
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