# The Effects of Plan Switching in Medicaid Managed Care on Access and Continuity of Care

> **NIH AHRQ R36** · UNIVERSITY OF MINNESOTA · 2021 · $36,392

## Abstract

Project Summary/Abstract
Most Medicaid beneficiaries receive coverage through a private Medicaid Managed Care (MMC)
plan. MMC plans compete for enrollees by offering high quality coverage with access to
desirable providers. States use competitive bidding to select high quality, low-cost MMC plans
for enrollees to choose from. Plan choice and competitive bidding can promote quality and
efficiency in MMC if enrollees sort into high quality plans and/or states are willing to exclude low
quality plans from their Medicaid programs. Both these mechanisms may require enrollees to
switch plans, which could also negatively affect quality if patients lose access to providers or
experience disruptions in their care due to these transitions. Despite the large and growing role
of MMC in covering vulnerable populations, little is known about how switching between MMC
plans affects health care quality or utilization. Data limitations, unstable enrollment, and state-
level policy differences make it difficult to produce evidence on how Medicaid patients’ health
care use changes after enrolling in a new MMC plan. This study examines the effect of plan
switching among people covered by Minnesota Health Care Programs (MHCP), Minnesota’s set
of Medicaid, Children’s Health Insurance Program, and Basic Health Plan options. I will evaluate
the impact of changing MMC plans on (1) longitudinal continuity of care and (2) utilization
outcomes, including outpatient visits, emergency room use, hospital admissions, and
preventable hospital admissions. My empirical strategy focuses on people enrolled in MMC
plans that were dropped from MHCP following Minnesota’s competitive bidding process.
Between 2014 and 2016, more than 400,000 people were forced to enroll in a new MHCP plan
because their previous plan did not bid on, or failed to win, a state contract to offer MMC
coverage. I will use a difference-in-differences framework to compare outcomes among
enrollees who experienced these “forced switches” to enrollees whose MMC plan remained
available. Data for this project comes from the Minnesota All Payer Claims Database. Findings
from this study will inform state policy makers and practitioners about the impact of plan
switching on health care access and quality for Medicaid patients. The results will help improve
state health care programs by evaluating how plan choice and contracting policies affect
continuity of care and health care use.

## Key facts

- **NIH application ID:** 10225064
- **Project number:** 1R36HS027699-01A1
- **Recipient organization:** UNIVERSITY OF MINNESOTA
- **Principal Investigator:** Christopher David Frenier
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $36,392
- **Award type:** 1
- **Project period:** 2021-04-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10225064

## Citation

> US National Institutes of Health, RePORTER application 10225064, The Effects of Plan Switching in Medicaid Managed Care on Access and Continuity of Care (1R36HS027699-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10225064. Licensed CC0.

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