State Medicaid Eligibility and Enrollment Policies and Rates of Medicaid Participation Among Disabled Supplemental Security Income Recipients
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Abstract:
In addition to providing income-maintenance payments to eligible participants, the Supplemental Security Income (SSI) program provides automatic Medicaid enrollment for applicants upon SSI award in most states. Other states require applicants to file a separate Medicaid application. Some use the SSI eligibility criteria for both programs; others use Medicaid eligibility rules that are more restrictive. The authors use matched monthly longitudinal administrative records to test whether automatic enrollment has a positive effect on Medicaid coverage. Using logistic regression with a combination of repeated cross-section and regression discontinuity approaches, they find positive effects of automatic enrollment on Medicaid coverage relative to other policies. The differences are attributable to a discontinuous increase in Medicaid coverage shortly after the final disability determination decision. The time lag arising from the often-lengthy disability determination process reduces the effectiveness of automatic enrollment, which depends critically on timeliness of the final award decision.Keywords:
Regression discontinuity design
Percentage point
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Medicaid is the government insurance program that provides health insurance to the poor. The effect of Medicaid eligibility on children’s health is of great concern. The literature survey demonstrates that Medicaid eligibility largely increased the utilization of medical service. However, there are few studies evaluating the effect of Medicaid eligibility on children’s health conditions. This paper use ‘days of school missed due to illnesses or injury’ as the measurement to illustrate the effect of Medicaid eligibility on children’s health. Four econometric models are used to fully analyze the effect of Medicaid eligibility on children’s health outcome. The four models are probit model, triprobit model, negative binomial model and endogenous negative binomial model. Medicaid eligibility and days of school missed due to illness or injury are positively correlated in all four models.
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This final rule implements provisions of the Affordable Care Act that expand access to health coverage through improvements in Medicaid and coordination between Medicaid, CHIP, and Exchanges. This rule finalizes most of the remaining provisions from the "Medicaid, Children's Health Insurance Programs, and Exchanges: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Exchange Eligibility Appeals and Other Provisions Related to Eligibility and Enrollment for Exchanges, Medicaid and CHIP, and Medicaid Premiums and Cost Sharing; Proposed Rule" that we published in the January 22, 2013, Federal Register. This final rule continues our efforts to assist states in implementing Medicaid and CHIP eligibility, appeals, and enrollment changes required by the Affordable Care Act.
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With ELE, a state's Medicaid and/or CHIP program can rely on another agency's eligibility findings to qualify children for public coverage. Using 2007 to 2011 quarterly enrollment data, we estimate difference-in-difference equations with quarter and state fixed effects to measure the effect of ELE on enrollment. The estimated impacts of ELE on Medicaid enrollment were consistently positive across model specifications, ranging between 4.0 and 7.3 percent. The analysis also finds that ELE increased Medicaid/CHIP enrollment. Our results imply that ELE has been an effective way for states to increase new enrollment or improve retention among eligible children.
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When comparing risk-adjustment approaches based on Medicaid status of Medicare beneficiaries, this analysis found that predicted spending levels varied depending on states’ Medicaid eligibility criteria.
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To estimate the impact of Express Lane Eligible (ELE) implementation on Medicaid/CHIP enrollment in eight states.2007 to 2011 data from the Statistical Enrollment Data System (SEDS) on Medicaid/CHIP enrollment.We estimate difference-in-difference equations, with quarter and state fixed effects. The key independent variable is an indicator for whether the state had ELE in place in the given quarter, allowing the experience of statistically matched non-ELE states to serve as a formal counterfactual against which to assess the changes in the eight ELE states. The model also controls for time-varying economic and policy factors within each state.We obtained SEDS enrollment data from CMS.Across model specifications, the ELE effects on Medicaid enrollment among children were consistently positive, ranging between 4.0 and 7.3 percent, with most estimates statistically significant at the 5 percent level. We also find that ELE increased combined Medicaid/CHIP enrollment.Our results imply that ELE has been an effective way for states to increase enrollment and retention among children eligible for Medicaid/CHIP. These results also imply that ELE-like policies could improve take-up of subsidized coverage under the ACA.
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This paper explores enrollment and cost estimates for providing Medicaid coverage to Alaskan children, pregnant women, and nonpregnant adults. It provides enrollment and expenditure estimates of implementing two Medicaid policy options using five different income eligibility criteria. Included are a description of health care reform options under Medicaid; health insurance coverage and health care expenditures under the current system; characteristics of the eligible population; and enrollment and expenditure estimates for selected expansion options. The report concludes with a future projection of expenditures and a discussion of who will pay for the cost of reform.
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The Medicaid Buy-In program provides health coverage to working adults with disabilities whose incomes or assets prevent them from qualifying for traditional Medicaid. Participants typically pay a premium in exchange for full Medicaid benefits. This report, which explores participation trends and the relationship between program design and participation, notes that enrollment grew dramatically in recent years, nearly tripling from 2001 to 2003. In addition, most participants had low earnings and were already connected to public assistance programs when they enrolled.
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The Affordable Care Act (ACA) of 2010 expanded eligibility for public health insurance, Medicaid, to nearly all adults ages 18-64 with household incomes below 138% of the federal poverty line and living in states that opted to participate in the Medicaid expansion. The ACA Medicaid expansion can potentially decrease reliance of disabled adults on the Supplemental Security Income program which provides Medicaid coverage as well as cash assistance to low-income individuals with disabilities. In the paper we estimate the effects of Medicaid expansion on the entry into the Supplemental Security Income in the first two years following the expansion launch in January 2014. We use data from the Social Security Administration and identify causal effects by exploiting cross state variation in Medicaid eligibility resulting from states’ decisions about whether to participate in the Medicaid expansion.
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This article explores the role of the Social Security Disability Insurance (DI) and Supplemental Security Income (SSI) cash benefit programs in providing access to public health insurance coverage among working-aged people with disabilities, using a sample of administrative records spanning 84 months. We find that complex longitudinal interactions between DI and SSI eligibility determine access to and timing of Medicare and Medicaid coverage. SSI plays an important role in providing a pathway to Medicaid coverage for many low-income individuals during the 29-month combined DI and Medicare waiting periods, when Medicare coverage is not available. After Medicare eligibility kicks in, public health insurance coverage is virtually complete among awardees with some DI involvement. Medicaid coverage continues at or above 90 percent after 2 years for SSI-only awardees. Many people who exit SSI retain their Medicaid coverage, but the gap in coverage between stayers and those who leave SSI increases over time.
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