Dynamics of Medicaid and SCHIP Eligibility Among Children: 1996-2000

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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
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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

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RESEARCH OBJECTIVE

1. To describe childrens 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

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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 lt19
• When child turns 19 remaining waves are
  right-censored

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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

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Methods (2)

• Eligible children grouped by duration of
  eligibility
• Always eligible
• Eligible for all observed waves
• 2) Sometimes eligible
• Eligible for only some observed waves
• 3) Never eligible

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Share of Children Eligible for Medicaid/SCHIP
1996-2000
SCHIP Begins
46
33
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Share of All Children Eligible for Medicaid/SCHIP
(58.9 million eligible)
66
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Comparison of Always, Sometimes, and Never
Eligible Child Populations
Always eligible
Infant
Parent Age lt25
Less than 100 FPL
One Parent or No Parent
10
Number of Spells of EligibilityAmong Sometimes
Eligible Children(43 million children)
56
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Eligibility Routes Over Course of Panel
forAlways and Sometimes Eligible Children
Always Eligible (15.9 mil.)
Sometimes Eligible (43 mil.)
SCHIP only
Multiple routes
Welfare only
Poverty only
Poverty only
Welfare only
SCHIP only lt1
53 of all eligible children were eligible
through more than one route.
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Overlap in Eligibility Between EVER Medicaid and
SCHIP Eligible Children
EVER Medicaid Eligible (52 mil.)
EVER SCHIP Eligible (25 mil.)
Not eligible for Medicaid
Eligible for SCHIP
Eligible for Medicaid
Not Eligible for SCHIP
27
73
32 of all eligible children were eligible for
both Medicaid and SCHIP.
13
Eligibility Before and After First SCHIP Eligible
Wave Among SCHIP Eligible Children (25.5 mil.)
Eligibility Prior to First SCHIP Eligible Wave
Eligibility After First SCHIP Eligible Wave
Never eligible in remaining waves
Eligible in all waves
Not eligible for Medicaid
Eligible for Medicaid in some prior wave
Eligible in some remaining waves
Excludes right-censored waves.
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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
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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

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POLICY IMPLICATIONS (1)

• Many children potentially served by both Medicaid
  and SCHIPthese safety nets are interdependent
• Restructuring of one program could have
  significant implications for other programs
  participation
• Policies supporting seamless transition are
  critical to minimizing disruption in coverage

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POLICY IMPLICATIONS - 2

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