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Transitions Between Medicaid, CHIP, and Exchange Coverage

The Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) requires states to coordinate eligibility and enrollment processes between Medicaid, separate State Children’s Health Insurance Programs (CHIP), and subsidized coverage on health insurance exchanges. These policies aim to reduce coverage gaps when a beneficiary experiences changes in income or other circumstances.

This brief summarizes MACPAC’s analysis of insurance affordability program enrollment data and beneficiary transitions among those programs in 2018. It also provides a discussion of policy approaches that have been proposed to help reduce gaps in coverage. MACPAC found that only about 3 percent of all adult and child beneficiaries who were disenrolled from Medicaid and CHIP, enrolled in exchange coverage within a year after disenrolling, which was lower than previous estimates. In addition, we found that most individuals who moved from Medicaid to the exchange had a gap in coverage; these gaps were longer for racial and ethnic minorities.