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HomeHealth InsuranceGuaranteeing Continuity of Look after People Transitioning from Medicaid to Market: Put...

Guaranteeing Continuity of Look after People Transitioning from Medicaid to Market: Put up-PHE Issues for States


Sabrina Corlette and Jason Levitis*

When the COVID-19 public well being emergency (PHE) ends, an estimated 5 to 6 million persons are projected to be disenrolled from Medicaid however eligible for subsidies on the Inexpensive Care Act Marketplaces. A lot of these shedding their Medicaid advantages can have well being wants requiring uninterrupted care. Medicaid enrollees are likely to have poorer well being than the final inhabitants and are disproportionately more likely to have diabetes, hypertension, bronchial asthma, psychological sickness or a substance use dysfunction. Even usually wholesome folks might be within the midst of a hospitalization, recovering from harm or trauma, or within the latter levels of being pregnant when their Medicaid advantages are terminated. Many, no matter well being standing, can have longstanding relationships with a household physician, OB/GYN, or pediatrician, or depend on continued entry to a specific prescription.

But individuals who transition from Medicaid to the Market will enroll in plans with completely different profit designs, drug formularies, supplier networks, and cost-sharing insurance policies than their Medicaid protection. Providers they beforehand obtained totally free might include deductibles or different cost-sharing. Hospitals and medical doctors might abruptly turn out to be “out-of-network,” which for many Market plans means their companies are not coated in any respect. Sufferers could also be required to re-submit paperwork to obtain prior authorization for companies that their earlier plan had already authorised. For state Medicaid companies, Market officers, and insurance coverage regulators, serving to folks keep continuity of insurance coverage protection is just a part of the problem. States might want to give equal consideration to making sure continuity of care.

Of their newest Professional Perspective for the State Well being & Worth Methods Challenge, Sabrina Corlette and Jason Levitis define a number of coverage and operational adjustments state-based Marketplaces and departments of insurance coverage can implement to assist transitioning people keep their entry to crucial well being care gadgets and companies. You possibly can learn the total article right here.

* Jason Levitis is a Senior Fellow with the City Institute’s Well being Coverage Heart



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