An Implementation Analysis of States' Experiences in Transitioning "Stairstep" Children from Separate CHIP to Medicaid

Publisher: Ann Arbor, MI: Mathematica Policy Research
Sep 03, 2015
Authors
Cara Orfield, Sean Orzol, and Lauren Hula

Key Findings:

  • Planning and operations. Medicaid and CHIP administrators in most of the study states began planning at least six months before the transition and involved agency staff, health insurance issuers, child health advocates, and provider groups in the planning discussions.
  • Continuity of care. Administrators in 4 of the 10 states proactively addressed continuity of care issues by either helping children enroll in a Medicaid health plan in which their existing primary care provider participated or encouraging separate CHIP primary care providers to accept Medicaid.
  • Challenges. The most common challenges state administrators faced when undertaking the transition related to technology, the administrative burden of simultaneously implementing other ACA-related policy changes, and educating families and providers about the transition.
  • Best practices for ensuring smooth transitions. State administrators believe that several factors contributed to smooth transitions for children and families, including close coordination within and across Medicaid and separate CHIP teams; clear and consistent communication with families, health insurance issuers, providers, and other stakeholders; and implementation of policies that ensure continuity of care.

The Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) required states to provide Medicaid coverage to all children with incomes up to 138 percent of the FPL beginning in January 2014, affecting 21 states that had been covering these children in separate CHIP. To shed light on the experience of the states required to transition these stairstep children from separate CHIP, the Medicaid and CHIP Payment and Access Commission contracted with Mathematica Policy Research to conduct a qualitative implementation analysis. The report describes strategies for planning and implementing the transition, as well as challenges experienced, in 10 states. The practices identified could inform how any future large-scale transitions of children’s coverage are implemented. 

This report was prepared under contract to the Medicaid and CHIP Payment and Access Commission (MACPAC). The findings, statements, and views expressed in this report are those of the authors and do not necessarily reflect those of MACPAC.