In 30 States, Plans Serving Medicaid Beneficiaries Also Offer Exchange Coverage, Improving Continuity of Care

October 21, 2013

Consumers in 30 states (60%) will have the option of at least one plan operating as both a qualified health plan (QHP) in the health insurance exchange and as a Medicaid managed care organization (MMCO), according to an Avalere analysis.

In these states, Medicaid beneficiaries may be able to enroll in a plan offered by the same insurer in the exchange based on whether their income increases over time.


“Plans that bridge Medicaid and exchanges represent an important new pathway to improve continuity of care. Consumers moving from Medicaid in one year and to exchanges the next will be more likely to stay with the same physicians and access the same medications,” said Matt Eyles, executive vice president at Avalere Health. 



Avalere’s analysis also found that consumers in 22 states (44%) will have two or more plans acting as both an MMCO and a QHP, which will offer greater choice among carriers straddling both markets. Some states, including California and Nevada, are pursuing strategies to further encourage plans to participate in both the Medicaid and exchange markets. 



“If more plans decide to bridge Medicaid and exchanges in the future, care continuity and quality could also improve through more consistent sharing of healthcare information about consumers who maintain coverage within the same organization,” said Eyles.