April 2014, by Miranda Dietz, Dave Graham-Squire, and Ken Jacobs
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Projections for enrollment in the new insurance options created under the Affordable Care Act (ACA) are often point-in-time estimates. But just as people frequently move in and out of being uninsured, insurance coverage through Covered California or through Medi-Cal is dynamic and can change for an individual over the course of a year. The authors predict that large numbers of Californians will continue to enter and leave Covered California and Medi-Cal throughout the year during Special Enrollment Periods due to life-changing "triggering" events such as divorce and job change.
This churn in enrollment is important to understand and predict. Using the California Simulation of Insurance Markets (CalSIM) model and the Survey of Income and Program Participation (SIPP), the authors predict that close to half of those enrolled in a Covered California plan and receiving federal tax subsidies at any point in time can be expected to leave that plan within 12 months. Others will enter the marketplace after they lose Medi-Cal eligibility or experience life-changing events such as divorce or job loss. For a given cohort of enrollees in Medi-Cal, about three-quarters are expected to remain enrolled in Medi-Cal after 12 months, while one in six are expected to experience income increases that will make them eligible for Covered California.
The authors emphasize that there will be significant fluidity in California's health insurance landscape year-round – not just during periods of open enrollment. Understanding the extent and nature of churn can help in planning for ongoing enrollment, ensuring smooth health coverage transitions and continuity of care, and reducing uninsurance.