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...private plan that covers subsidized Commonwealth Care members as well as MassHealth Medicaid members, believes programs will continue to struggle until one particular problem is solved: enrollment churning.

Churning--the cycle of enrollment, loss of coverage and subsequent re-enrollment of the same members year after year--causes administrative burdens and costly gaps in care. In most cases, it's not matter of eligibility that causes the disenrollment, it's a matter of paperwork. Aside from policy changes that affect eligibility, churning remains a practical administrative issue that costs money, Severin says.

"We looked at 88,000 of our MassHealth members," she says. "Fifty-eight percent were disenrolled annually. Of those. 47% re-enrolled within 30 days. Of all those who re-enrolled. 70% did so within 90 days."

Disenrolled by Default

There is a 45-day window in which members in Common-wealth Care or MassHealth must re-enroll, recently reduced from 60 days. Members who miss that window, fail to complete paperwork or fail to submit supporting documents--even if they remain eligible for benefits--are automatically disenrolled by the state.

Often members miss re-enrollment because reminders and materials do not reach them, Severin says. She believes churning might be reduced if the challenging reenrollment process itself were simpler for members and took into account the fact that people receiving public assistance are difficult to reach. For example, only 25%...

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