Eligibility Transitions under the Affordable Care Act: Policy Considerations for Ensuring Coverage Continuity Among Rural Residents

Research center:
Lead researcher:
Project funded:
September 2012
Project completed:
August 2018

The Affordable Care Act's effectiveness in ensuring coverage stability and minimizing disruptions depends, in part, on how states prepare for movement between their Exchanges and Medicaid programs. Evidence indicates that even small lapses in health insurance coverage can affect access to health care services. In addition, the issue of churning between programs can lead to greater administrative costs for states.

To the extent that rural residents are more likely to experience eligibility fluctuations, this could be a particular problem for states with large rural populations. This study used the 2008 panel of the Survey of Income and Program Participation (SIPP) to compare rural-urban rates of income transitions within and across calendar years and identify the characteristics associated with any differences. Products included a policy brief and journal article submission designed to aid policymakers in considering how best to minimize insurance transitions for rural residents.


  • Medicaid Income Eligibility Transitions Among Rural Adults
    Policy Brief
    Maine Rural Health Research Center
    Date: 08/2018
    The Affordable Care Act allows Medicaid expansion to adults under 65 with income below 138% of poverty. Research suggests income shifts affecting Medicaid eligibility are common, but the rural impact is unclear. This national study examines rural and urban adults' annual income shifts above or below the Medicaid expansion eligibility threshold.