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Stabilizing Coverage for Children and Families |
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This report examines the extent, causes, and consequences of instability in public coverage programs for children and families. It focuses particularly on the phenomenon of "churning," which occurs when individuals lose and regain coverage in a short period of time. The experiences of these states demonstrate that coverage instability can be averted to a significant degree by adopting key policies and procedures, like limiting the frequency of required renewals; developing easy, seamless transitions among public coverage programs; and setting affordable limits on premium costs. People covered through employer-based insurance may lose coverage if they change jobs, their employer decides to stop offering insurance, or their share of the cost of the coverage becomes unaffordable. This report examines the extent, causes, and consequences of instability in public coverage programs for children and families. It focuses particularly on the phenomenon of "churning," which occurs when individuals lose and regain coverage in a short period of time, suggesting that the loss of coverage is not due to eligibility factors. Paying attention to the problem of coverage instability within public insurance programs, chiefly Medicaid and the State Children's Health Insurance Program (SCHIP), makes sense for several reasons. Medicaid and SCHIP officials, as well as health plans and providers that serve Medicaid and SCHIP enrollees, report significant costs related to churning. While there is no single source of data on the extent of instability and churning in Medicaid and SCHIP, program administrators, health plan executives, and health providers agree that the problem is substantial. Premiums in SCHIP and Medicaid may contribute to coverage instability and churning, under certain circumstances, and recent federal law changes might prompt more states to consider imposing premiums.
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