Continuing with the Same Issuer in Transitions Between Medicaid and the Marketplace: Premium Assistance Models in Arkansas, Iowa, and New Hampshire

Many low-income adults experience fluctuations in income and household composition that affect their eligibility for Medicaid versus Marketplace subsidies, causing churning between public and private coverage. Smoothing these coverage transitions was one objective of section 1115 demonstrations in Arkansas, Iowa, and New Hampshire, which expanded Medicaid coverage to beneficiaries with incomes up to 133 percent of the federal poverty level and offered premium assistance to support new beneficiaries’ enrollment in qualified health plans (QHPs) based on those available in the Federally Facilitated Marketplace. Beneficiaries who transition between coverage types are more likely to be able to stay enrolled with the same issuer and keep the same providers when the same issuer offers plans in both settings in a given state. To examine the potential for continuity of coverage across settings, we used information on issuer participation to assess the overlap between Marketplace and premium assistance issuers, as well as the overlap between issuers offering Medicaid managed care plans and QHPs in the states that served as comparisons to the demonstration states.