the urban institute preliminary: not for quotation or distribution dynamics of medicaid and schip...

THE URBAN INSTITUTE Preliminary: Not for Quotation or Distribution

Dynamics of Medicaid and SCHIP Eligibility Among Children:

1996-2000 Anna Sommers, Ph.D., The Urban Institute

Lisa Dubay, Sc.D., The Urban Institute

Linda Blumberg, Ph.D., The Urban Institute

Fred Blavin, B.A., The Urban Institute

John Czajka, Ph.D., Mathematica Policy Research Group, Inc.

AcademyHealth Annual Research Meeting

Boston, MA

June 26, 2005

Funded by the Health Care Financing Organization (HCFO), Robert Wood Johnson Foundation, Grant #049257


Studies Estimating Change in Share of Children Eligible for Public Programs

Study Data Period Increase

Lo Sasso & CPS 1996-2000 30 to 41%

Buchmueller (2004)

Selden et al. (2004) MEPS 1996-2002 29 to 47%

Dubay et al. (2005) NSAF 1997-2002 34 to 48%


RESEARCH OBJECTIVE

1) To describe children’s eligibility patterns for Medicaid and SCHIP over the four-year period 1996-2000

2) Characterize eligible children based on child and family characteristics

3) Examine dynamics of eligibility based on number and length of spells, change in routes over the panel, and coverage during eligible waves


Data• 1996 Survey of Income and Program Participation (SIPP)

– Dec 1995 – Feb 2000– Nationally representative U.S. sample– Interviewed every 4 months

• Eligibility microsimulation– TRIM3 simulates public program eligibility– Only use data from each month just prior to interview

• Sample size:– Longitudinal sample of 21,888 children age <19– When child turns 19 remaining waves are right-censored


Methods (1)

Eligible waves classified by route of eligibility:1) Welfare-related Medicaid eligible via

• AFDC/TANF• Section 1931

2) Poverty-related Medicaid eligible via• Expansions above Section 1931• Section 1115 waiver• Medically Needy

3) SCHIP-eligible


Methods (2)

Eligible children grouped by duration of eligibility:

1) Always eligible– Eligible for all observed waves

2) Sometimes eligible– Eligible for only some observed waves

3) Never eligible


Share of Children Eligible for Medicaid/SCHIP 1996-2000

0%5%

10%15%20%25%30%35%40%45%50%

1 2 3 4 5 6 7 8 9 10 11 12

Wave

OverallWelfarePovertySCHIP

33% 46%SCHIP Begins


Share of All Children Eligible for Medicaid/SCHIP (58.9 million eligible)

Never Eligible

Always Eligible

Sometimes Eligible

48%

18%

34%66%


Comparison of Always, Sometimes, and Never Eligible Child Populations

80

69

35

25

3

14

17

16

3025

14

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Always

Sometimes

Never

Infant Parent Age <25

Less than 100% FPL

One Parent or No Parent

Always eligible


Number of Spells of EligibilityAmong Sometimes Eligible Children

(43 million children)

1 spell

2 spells

3+ spells

38%

18%

44%56%


Eligibility Routes Over Course of Panel forAlways and Sometimes Eligible Children

59%

24%

16%

Always Eligible (15.9 mil.) Sometimes Eligible (43 mil.)

51%

16%

28%

6%

53% of all eligible children were eligible through more than one route.

Multiple routesSCHIP only

Poverty only

Welfare only

Poverty only

Welfare only

SCHIP only <1%


Overlap in Eligibility Between EVER Medicaid and SCHIP Eligible Children

64%36%

EVER Medicaid Eligible (52 mil.) EVER SCHIP Eligible (25 mil.)

32% of all eligible children were eligible for both Medicaid and SCHIP.

Eligible for SCHIP

27%

73%

Eligible for Medicaid

Not eligible for Medicaid

Not Eligible for SCHIP


Eligibility Before and After First SCHIP Eligible Wave Among

SCHIP Eligible Children (25.5 mil.)

68%32%

Eligibility Prior to First SCHIP Eligible Wave

Eligibility After First SCHIP Eligible Wave*

42%

40%

17%

*Excludes right-censored waves.

Eligible for Medicaid in some prior wave

Not eligible for Medicaid

Eligible in some remaining waves

Never eligible in remaining waves

Eligible in all waves


Coverage During Eligible Waves Among All Eligible Children

Insurance in Eligible Waves

Eligible

Children

Always Eligible

Sometimes Eligible

Medicaid or SCHIP

(any)

46% 81% 30%

Private Insurance

(any)

66 36 78

Uninsured in ANY eligible wave

42 54 37

Uninsured in ALL eligible waves

7 6 8


SUMMARY

• The share of children eligible for public coverage increased substantially in 1996-2000, changing the composition of the eligible population.

• Fluctuation in eligibility and across programs was common.

• Even children with long eligibility spells or always eligible report high exposure to uninsurance while eligible


POLICY IMPLICATIONS (1)

• Many children potentially served by both Medicaid and SCHIP—these safety nets are interdependent

• Restructuring of one program could have significant implications for other program’s participation

• Policies supporting seamless transition are critical to minimizing disruption in coverage


POLICY IMPLICATIONS - 2

• Uninterrupted eligibility might not be sufficient to protect children from disruptions in coverage

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