Managed Care
Plan Switching Creates Continuity of Care Barriers for Medicaid Enrollees
Americans switching health plans to find affordable coverage face disruptions in provider networks and medication access. These continuity-of-care challenges affect patient outcomes and care coordination when enrollees move between health plans. The barriers include prior authorization requirements for existing medications, loss of established provider relationships, and administrative complexity in maintaining treatment regimens. For Medicaid managed care organizations, member churn and plan transitions create operational challenges in maintaining quality metrics and member satisfaction while managing care continuity requirements.
Why it mattersMCOs face heightened care coordination challenges and potential quality score impacts when members switch plans mid-treatment, particularly as Medicaid redeterminations continue and members move between coverage sources.