PREGNANCY-RELATED CHURN AND ACCESS TO CARE IN THE CONTEXT OF NARROW NETWORKS IN WASHINGTON STATE
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Much is still unknown about the practical impact of narrowing networks and network adequacy on access to care for pregnant women who churn between Medicaid and Qualified Health Plan (QHP) coverage due to an eligibility overlap on their access to health care. This capstone report, conducted in collaboration with Northwest Health Law Advocates (NoHLA), seeks to better understand this impact within the construct of access to OB/GYN providers; first, by examining both the federal and state legal landscapes around network adequacy; second, by exploring to what extent providers are shared across Medicaid and QHP networks by conducting a comparison analysis of King County OB/GYN providers covered by carriers using online provider directories; and third, by providing recommendations to address the challenges and findings. The analysis compared King County OB/GYN provider networks for the insurance carriers certified to sell 2016 QHPs on the Washington Health Benefit Exchange to Medicaid’s, finding an average overlap amount of 67.4% of listed providers with carrier’s ranging from 45.8% to 81.9% of overlap. These findings raise concerns relating to women’s access to consistent maternal care over the course of pregnancy during a churn event, while underscoring the need to address the challenges around churn and narrow networks. Policy-makers and regulators can begin to address such challenges by creating and enforcing substantive network adequacy standards, providing consumers with information on accessing out-of-network providers while ensuring recourse for consumers impacted, and lastly by strengthening and enforcing requirements that ensure provider directory information is current, accurate and actionable.
- Health services