potentially eligible medicaid population without medicaid coverage
TRANSCRIPT
Potentially eligible Medicaid population
without Medicaid coverage
Authors:– Gerry Fairbrother, PhD– Joseph Schuchter, MPH
Reviewers:– Lorin Ranbom– David Dorsky– Tom Scheid
Insurance is a critical precursor for health
• Insurance = appropriate, quality care: medical home, regular check-ups, etc.
• No insurance or unstable coverage leads to individual costs:– Unmet needs, delayed care, bankruptcy
and societal costs:– “A Shared Destiny”, IOM 2003
Most of the uninsured are eligible
< 63%
63-100%
101-150%151-200%
201-250%
251-300%
301% << 63%
63-100%
151-200%
201-250%
251-300%
101-150%
301% <
Uninsured children: FPL Uninsured parents: FPL
Two-thirds of uninsured children meet income requirements
One-third of uninsured parents meet income requirements
Study purpose:
• To examine the uninsured and unstably insured parents and children who are eligible for public coverage to learn:– who they are– how they differ from insured individuals– why they are not covered
Analysis restricted to eligible children and parents
• Eligible children:– Households <150% FPL– Households 150-200% FPL w/out other coverage
• Eligible parents:– Households <100%FPL– parent, foster parent, legal-guardian, or step-
parent to at least one family member aged 17 or younger living in their household
Insurance status
• Current status– Participating– Not participating
(uninsured)– Other
• Year-long status– Full-year insured– Part-year insured
(unstable)– Full-year uninsured
(chronically)
Insurance classification of children and parents, current and year-long status
Current and year-long insurance status of eligible children and parents
Medicaid: Unstable
5%
Uninsured: Unstable
3%
Uninsured: Full-year
4%
Medicaid: Full-year
60%
Other insurance
28%
Medicaid: Unstable7%
Uninsured: Unstable7%
Uninsured: Full-year19%
Medicaid: Full-year40%
Other insurance27%
Children Parents
Current | Year-long Number Percent Number Percent
Medicaid Full year 676,805 60 166,702 40
Medicaid Part-year 51,582 5 26,718 7
Uninsured Part-year 28,727 3 29,441 7
Uninsured Full year 47,073 4 75,954 19
Other ins. 309,187 28 111,253 27
Children Parents Children Parents Race/ Ethnicity Odds Odds Parent Insurance type (current) Black Non-Hispanic 1.0 1.0 Medicaid 1.0 na White/ Other Non-Hisp** 2.0 * 1.2 Medicare 9.7 * - Hispanic 5.6 * 8.2 * Job-based 8.3 * - Asian Non-Hispanic 0.2 * 1.1 Other 16.5 * - # adults in family Uninsured 45.0 * - One 1.0 1.0 Special Health Care Need Two 2.8 * 2.0 * Yes 1.0 1.0 Federal Poverty Level No 1.9 * 1.8 * < 63% 1.0 1.0 Mental Health Status
63-100 1.1 1.5 * Excellent-Very Good 1.0 ns 101-150 1.8 * na Good-Poor 0.6 * - 151-200 3.5 * - Gender Region Male ns 1.0 Appalachian 1.0 Female - 0.3 * Metropolitan 1.2 Rural Non-App. 1.6 * Suburban 1.5
Likelihood of not participating in Medicaid and being uninsured; univariate analysis
Children’s participation
• 77,000 eligible uninsured children– upper end of the income eligibility spectrum– have two adults in the family – of Hispanic race/ethnicity– no special health care need– rural non-Appalachian area– PARENT WHO IS NOT ON MEDICAID
Parent’s participation
• 105,000 eligible uninsured parents– upper end of the income eligibility spectrum– have two adults in the family – of Hispanic race/ethnicity– no special health care need– male
Children Parents Children Parents Race/ Ethnicity Odds Odds Parent Insurance type (current) Black Non-Hispanic 1.0 1.0 Medicaid 1.0 na White/ Other Non-Hisp** 2.3 * 1.1 Medicare 10.3 * - Hispanic 9.1 * 12.7 * Job-based 5.1 * - Asian Non-Hispanic 0.4 2.1 Other 13.1 * - # adults in family Uninsured 49.8 * - One 1.0 1.0 Special Health Care Need Two 3.7 * 2.4 * Yes 1.0 1.0 Federal Poverty Level No 2.6 * 2.1 * < 63% 1.0 1.0 Gender
63-100 1.0 1.7 * Male ns 1.0 101-150 1.6 * na Female - 0.3 * 151-200 3.0 * - Region
Appalachian 1.0 Metropolitan 1.4 Rural Non-App. 1.8 *
Suburban 1.4
Likelihood of being uninsured all-year *, univariate analysis
* Uninsured for a full-year compared to insured for a full-year
Unstable and chronic uninsurance
• Associated w/ the same characteristics predicting participation in children and parents
Why uninsured in the past 12 months?
Primary reason for being uninsured in the past 12m, percent of currently uninsured children and parents
10
8
4
3
5
5
6
8
9
10
32
9
2
3
3
5
11
3
16
9
5
34
0 10 20 30 40
Miscellaneous (known)
Other
Don't know
Don't need
Didn’t want
Employer doesn’t provide
Waiting to become eligible
Not working
Make too much
Lost coverage, unspecified
Cost too high
% of respondents
ParentsChildren
Why no longer have Medicaid?
Primary reason for no longer having Medicaid, children and parents, by current insurance status
10
2
4
6
33
45
22
5
11
15
15
32
5
0
0
3
33
59
31
2
0
11
19
37
0 10 20 30 40 50 60
Other reasons
Waiting to become eligible
Didn't need
No longer qualify - other
Obtained other coverage
Make too much
CURRENTLY HAVE OTHER COVERAGE
Other reasons
Obtained other coverage
Waiting to become eligible
Paperwork problems
No longer qualify
Make too much
CURRENTLY UNINSURED
% of respondents
ParentsChildren
Why unable to get Medicaid? Why didn’t anyone try?
Primary reason child was unable to get Medicaid and family didn’t try to get, among children uninsured currently and
for part or all of the past 12 months
16
7
0
3
13
19
21
21
10
3
0
22
65
8
22
8
9
12
19
3
19
6
7
24
40
23
0 10 20 30 40 50 60 70
Other unspecified
Other miscellaneous
Doesn't want
Didn't know about
Doesn't need
Make too much
Already has insurance
Didn't think was eligible
WHY DIDN'T TRY TO GET?
Other unspecified
Other miscellaneous
Application denied
Make too much
Application in process
WHY UNABLE TO GET?
% of respondents
Full-year uninsuredPart-year uninsured
Health utilization and needs among eligible children, by year-long insurance status
80
70
71
78
79
74
43
83
84
73
81
84
75
60
96
88
97
95
95
92
75
40 50 60 70 80 90 100
Getting needed care
Usual source of sick care
No delayed care
No other unmet needs
No prescription drug needs
No dental needs
Well-child visit last 12m
% of respondents
Full-year insuredPart-year insuredFull-year uninsured
Health utilization and needs among eligible parents, by year-long insurance status
65
46
63
67
54
54
38
51
53
54
91
86
90
91
81
30 40 50 60 70 80 90 100
Getting needed care
No delayed care
No other unmet needs
No prescription drugneeds
No dental needs
% of respondents
Full-year insuredPart-year insuredFull-year uninsured
Insurance works
• General increase in care received and decrease in unmet needs, for both children and parents
• Most notable difference in the % of children with a well child visit in the last year: children with a full-year of Medicaid coverage
• Must be continuous to be effective: those with unstable (part-year) coverage have a level of unmet needs similar to those uninsured for a full-year
Implications
• address confusion among working families about eligibility requirements
• more linguistically and culturally sensitive outreach• enable families to obtain coverage they value; few of
the eligible uninsured didn’t want or need Medicaid• further simplify enrollment and renewal processes to
reduce burden on families and eligibility workers• solutions to increase enrollment must be multi-
faceted, using both simplification and outreach