Continuity of Care Issues Between the Maryland Health Benefit Exchange and Mary

Recommendations for further study by the Continuity of Care Committee

The Affordable Care Act (ACA) ushered in a new age of health care reform in the United States that will open up health insurance coverage for millions of people. The law provides for tax credits and cost sharing subsidies to assist low-income individuals and families between 100 and 400 percent of the Federal Poverty Level (FPL) in purchasing insurance through the Health Benefit Exchange. It codifies strong rules to prevent insurance companies from denying coverage to individuals with preexisting conditions, ensuring access to affordable and comprehensive coverage. The ACA also expands Medicaid by raising the income limit for parents up to 138 percent of the FPL and ? for the first time without a special waiver ? allowing states to cover childless adults at the same income limits as parents.
The ACA determines eligibility for Medicaid and the Exchange principally on income. By definition, therefore, eligibility for these programs is sensitive to income fluctuations and changes in family composition. The result will be that a large number of individuals will move between Medicaid and the Exchange. This churning can impact the care that individuals receive, particularly individuals that are frequent users of health care services. Providers may participate in plans offered through the Exchange, but not always with Medicaid plans. The benefit packages between Medicaid and Exchange plans will be slightly different, causing individuals to lose or gain benefits as they cycle between the systems.
In light of these concerns, the General Assembly tasked the Maryland Health Benefit Exchange with drafting a report on continuity of care issues in the State of Maryland. The Exchange, in turn, has created a Continuity of Care committee (the Committee) to advise policymakers on solutions to minimize the negative impact of churning on individuals? health care. This paper is intended to help begin the Committee?s discussion of the issues and to help Exchange staff design a Request For Proposal (RFP) for a vendor to complete a comprehensive study on continuity of care issues for the Exchange.

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