Issue Briefs | Aug 4, 2011

Ten Considerations for States in Linking Medicaid and the Health Benefit Exchanges

Center for Health Care Strategies – Carolyn Ingram, Suzanne Gore and Shannon McMahon

An estimated 27 million people will gain coverage through Medicaid or private qualified health plans via the new health insurance exchanges once the Affordable Care Act (ACA) is fully implemented in 2014. It is estimated that a significant percentage of those obtaining coverage will have income fluctuations that will change their eligibility status between public and private coverage options offered through the exchanges. This brief, authored by the Center for Health Care Strategies, analyzes opportunities for linkages between public and private coverage, explaining that linkages should seek to streamline administration across programs and facilitate seamless transitions between programs. Continuity of benefits, providers and health plans is critical to ensuring seamless affordable coverage for exchange consumers. This brief outline an approach for states and continuity issues that should be considered while implementing ACA’s exchange and Medicaid expansion requirements.

Related analyses on seamlessness options and Medicaid managed care lessons for exchanges are also available.