This case study is part of the Medicare Rights Center’s series on making Medicare and Medicaid work better together, which uses real client stories from Medicare Rights’ national helpline to highlight how gaps in coordination affect access to care. The series is designed to help policymakers, advocates, and beneficiaries better understand the challenges of navigating two separate systems and to identify opportunities to improve integration, reduce confusion, and ensure people can access the full range of benefits available to them.
In Stopping Coverage Loss and Disruption, the case study focuses on “churn,” or the loss and regaining of coverage, and how it can interrupt care and destabilize integrated plans. Mrs. E’s experience shows how administrative errors in Medicaid recertification can lead to the loss of both Medicaid and integrated D-SNP coverage, resulting in higher costs, missed care, and fragmented services. Mr. V’s story highlights how misleading marketing and confusion about plan options can push beneficiaries out of highly integrated coverage into less coordinated plans, putting critical services like home care at risk. Together, these cases underscore the need for stronger safeguards, clearer communication, and streamlined processes to prevent unnecessary coverage disruptions and protect access to care.
