Promoting Care and Continuity of Coverage
In 2017, more than 1.7 million Washingtonians are enrolled in health coverage, many for the first time, through Medicaid and Affordable Care Act programs. Beginning in January 2014, the Affordable Care Act allowed Washington State to expand significantly the Medicaid program (now called Apple Health) and to begin offering Qualified Health Plans (QHPs) through the Washington Health Benefit Exchange (HBE), an online health insurance marketplace.
A family's income determines whether they enroll in Apple Health or a QHP. When income or other circumstances change, people may transition from one coverage type to another or lose coverage altogether. These individuals must have uninterrupted access to the health plan they prefer and the doctors they trust. That requires simple and seamless transitions between programs. Refinements to the system and increased coordination between state agencies and HBE are needed to avoid "churn" - harmful and costly disruptions in care and coverage.
One area of specific concern relates to women enrolled in a Qualified Health Plan who become pregnant and may elect to enroll Apple Health for Pregnant Women coverage based on income. This could result in disruptions in care referred to as "pregnancy churn." An example of this is losing access to the person’s care providers because they do not have a contract with the newly-assigned Apple Health managed care plan. Pregnant women may be eligible for Apple Health for Pregnant Women coverage if their income is under 198% of the federal poverty level. Read our issue brief on pregnancy churn to learn how this could affect your care and what you can do to prevent or address potential disruptions.
NoHLA continues to be concerned about people who experience churn, which can occur in a variety of situations. Some examples are people moving from Apple Health to QHPs, and people with employment status changes.
Nearly 1 in 3 Washingtonians received a surprise medical bill in the past two years, according to a new Consumer Reports Survey. To protect consumers from surprise billing, NoHLA is teaming up with the Consumers Union to support House Bill 2447, a measure requested by state Insurance Commissioner Mike Kreidler.
Read more here.