The Medicaid to ACA transition is shaky

In 2020, Congress passed the Families First Coronavirus Responce Act (FFCRA).  FFCRA did a lot of things.  One of the big things it did was support state budgets and health coverage by increasing the Federal Matching Assistance Percentage (FMAP).  FMAP is the percentage of allowed program costs that the federal government pays.  It is determined by a state’s income.  Typically it ranges from a floor of 50% to just under 80%.  FFCRA did two big Medicaid things.  First it increased the FMAP across the board by 6.2% percentage points.  Secondly, it required states that accepted this bump payment to not disenroll folks.  This continuous coverage requirement ended in the last budget agreement.  States have started to redetermine enrollees this spring.

Early projections expected ~15 million people to lose Medicaid coverage.  Many folks would receive coverage elsewhere because their lives changed.  However a decent percentage of this 15 million people who lost Medicaid would need to find new coverage.  Many would be eligible for the ACA.

The problem is that historically the Medicaid to ACA interface is not too good.  Earlier this year, in JAMA Network Open Chris Frenier and Adrianna McIntyre looked at where pre-pandemic Minnesota Medicaid enrollees found coverage in the year after they lost Medicaid coverage:

Six months after leaving Medicaid, 17.6% of children had enrolled in commercial group coverage, and 2.2% of children had enrolled in individual coverage. Among children, 48.7% did not have identifiable MN APCD coverage at 6 months, decreasing to 29.8% after 12 months, largely because of Medicaid reenrollment; 51.2% of children who left the program were reenrolled 1 year later.

Among adults, 50.1% did not have identifiable coverage 6 months after Medicaid exit, decreasing to 39.1% at 12 months. The share of adults covered by commercial coverage after 12 months was 13.6% for group plans and 5.9% for individual plans. The share who had returned to Medicaid at 12 months was 32.8%.

Just over 2% of kids and just under 6% of adults who lost Medicaid coverage in Minnesota enrolled in the Minnesota exchange in the year after coverage loss.

Maybe this data is old. Maybe there was low awareness in 2017 and the Minnesota state based marketplace imposed idiosyncratic administrative burdens that it had not thought about? Maybe things changed?

Well….

Amy Lotven at Inside Healthcare reports on new CMS data from the Medicaid unwinding

New CMS data , quietly released in late August, show about 178,000 consumers chose a qualified health plan (QHP) through state or federal exchanges after losing Medicaid and CHIP coverage in the first two months of the Medicaid unwinding

As more adults are redetermined out of Medicaid, states should be aggressively linking these newly uninsured or likely to be uninsured folks to the ACA.  There, they are likely to face higher premiums and more cost-sharing.