The Affordable Care Act has expanded coverage to 20 million newly insured individuals, split between state Medicaid programs and commercially insured marketplaces, with limited integration between the two. The seamless continuum of coverage envisioned by the law is central to achieving the full potential of the Affordable Care Act, but it remains an elusive promise.

In a new issue brief for the Commonwealth Fund, Manatt Health examines the historical and cultural differences between state Medicaid agencies and insurance departments that contribute to this lack of coordination and maintains that historical and cultural differences must be overcome to ensure continuing access to coverage and care. The issue brief presents two opportunities for insurance and Medicaid officials to work together to advance the continuum of coverage: alignment of regulations for insurers participating in both markets and collaboration on efforts to reform the health care delivery system.