Medicaid is a government-funded health insurance program that provides low-income individuals and families with medical coverage. However, when these people get a boost in income due to seasonal work or lengthier shifts, their income level increases and they are momentarily no longer eligible for Medicaid. This cycle is known as Medicaid churning and according to the Washington Post, it could continue to be a problem as patients move between health exchanges and Medicaid.

The source noted that Medicaid churning could become expensive for states as well as insurance companies, and the gaps in insurance coverage could cause people to have to switch doctors or plans. Now with the Affordable Care Act, those typically on Medicaid will be able to get insurance and subsidies through the health care exchanges, but churning will continue as men and women bounce between Medicaid and the exchanges depending on their current income level.

"This is a critical issue for the states and the providers," Jenna Stento, a senior manager who tracks the health law at ­Avalere Health, a consulting firm, told the Washington Post. "They are worried about patients experiencing gaps in coverage. It could be a very significant population that is moving back and forth."

Matthew Buettgens, senior research analyst at the Urban Institute, said in Newsmax that this year alone, approximately nine million people will shift between exchanges and Medicaid. He also noted that churning was not given much consideration while planning took place for the expansion of the Medicaid program during the launch of Obamacare.

States are looking to solve this churning issue
Matt Salo, executive director of the National Association of Medicaid Directors, told the Washington Post that states are looking at options to solve the issue.

"You want people to have ­consistent insurance coverage, whether you're dealing with someone who's got mental health and substance abuse issues or a variety of undertreated chronic conditions," he said. "If you get them into Medicaid at one point and get them stable and on a plan of care, you don't want a transition into a different plan to set them back, and then have those people rebound back into Medicaid."

Some states have made attempts to deal with the problem, such as Nevada, which will require Medicaid-managed care companies to provide comparable plans this year on the exchanges. Washington is another state that developed a program to assist health care companies in the exchange also offer Medicaid plans if they provide patients with an identical network. Delaware companies in the exchange are required to continue coverage of approved medical treatment and medications for new Medicaid members during transitions, and in Congress, a bill sponsored by two Texans would mean states must guarantee a year of continuous eligibility for those on Medicaid to reduce churning. In Oregon, an advisory committee is reviewing options and information from other states for six months before creating a plan.

"The bottom line is we want to make sure people and their families are getting the care they need and that it's a smooth transition," Jeanene Smith, chief medical officer for the Oregon Health Authority said in an interview with the Washington Post.