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Insurers in 30 States Offer Coverage in Both Medicaid and Marketplace

By Rebecca Adams, CQ HealthBeat Associate Editor

October 21, 2013 --The problem of churning—when a person's eligibility for Medicaid changes because of an increase or dip in income—may be mitigated in 30 states where some insurers are offering plans to both individuals who get coverage through the new marketplace and those who qualify for Medicaid.

A new analysis by Avalere Health that was recently released shows that in these 30 states, people who are signing up for coverage will have the opportunity to enroll in a plan offered by an insurer that serves both people in the exchanges and people in Medicaid.

The analysis also shows that people in 22 of those states will have more than one plan to choose from by an insurer that serves both populations.

The benefits in the plans for the two populations would not be identical, Matt Eyles, executive vice president at Avalere Health, said in an interview, but they would be similar. Medicaid enrollees would probably get some additional benefits, such as help with transportation costs or lower cost-sharing, such as co-pays, that aren't available for people who buy plans through the marketplaces.

But a major plus for people in those states whose income might fluctuate is that they would not have to switch to a new insurance company, with new rules, networks of doctors and drug formularies.

"Consumers moving from Medicaid in one year and to exchanges the next will be more likely to stay with the same physicians and access the same medications," said Eyles.

That could lead to better health outcomes for patients because there would be fewer disruptions in service and less of a risk that a doctor who is starting to care for the patient might try treatments that have failed in the past.

The Avalere website contains a map showing which states offer similar plans for both populations.

Some states are considering an idea that would go slightly further. Arkansas is using Medicaid dollars to buy Medicaid beneficiaries the same plans that are available in the marketplaces. The state will then use Medicaid dollars to beef up benefits, such as lowering co-pays, for Medicaid enrollees.

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