Churn Toolkit: Stabilizing Coverage for Children and Families

Churn—cycling in and out of insurance coverage or between types of coverage—is a persistent and challenging characteristic of our health insurance landscape. Churn can disrupt an individual's care by interrupting the patient-provider relationship, complicating access to medications, or causing a consumer to delay care. Moving in and out of coverage also leaves consumers at risk of incurring significant financial burdens. The effects of churn on children, many of whom are covered through Medicaid and CHIP, can be especially problematic, as children require frequent contact with the health care system for preventative services, developmental needs, and routine and acute care.

In many cases, uncertainty about the causes of churn adds complexity to our efforts to resolve this issue. Many different policy and administrative levers, can contribute to churn, and these causes require carefully tailored policy solutions.

This toolkit is designed to aid advocates in obtaining the data they need to understand the scope and causes of churn in their state's Medicaid/CHIP program(s), as well as resources to select policy approaches to resolving the causes they identify. Additionally, we have provided resources on the costs of churn and success stories of states that have adjusted their practices to reduce churning. We have also provided a guide for advocates who work directly with consumers and want to help individual families avoid losing coverage.

Resources in the toolkit include:

We welcome suggestions to improve this toolkit, including policy approaches and additional success stories. Contact Kate Lewandowski at

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