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
THE URBAN INSTITUTE
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Studies Estimating Change in Share of
Children Eligible for Public Programs
Study
Period
Increase
Lo Sasso &
CPS
Buchmueller (2004)
1996-2000
30 to 41%
Selden et al. (2004) MEPS
1996-2002
29 to 47%
Dubay et al. (2005)
1997-2002
34 to 48%
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Data
NSAF
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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
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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 <19
– 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:
1) 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
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
SCHIP
Begins
33%
46%
Overall
Welfare
Poverty
SCHIP
1
2
3
4
5
6
7
8
9
10
11
12
Wave
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Share of All Children Eligible for
Medicaid/SCHIP (58.9 million eligible)
Always
Eligible
Never
Eligible
18%
34%
66%
Sometimes
Eligible
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48%
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Comparison of Always, Sometimes, and
Never Eligible Child Populations
90%
80
Always eligible
80%
Always
Sometimes
Never
69
70%
60%
50%
35
40%
30%
30
25
20%
10%
25
14
16 14
7
3
1
0%
Less than One Parent
100% FPL or No Parent
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Infant
Parent
Age <25
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Number of Spells of Eligibility
Among Sometimes Eligible Children
(43 million children)
3+
spells
18%
1 spell
56%
44%
38%
2 spells
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Eligibility Routes Over Course of Panel for
Always and Sometimes Eligible Children
Always Eligible (15.9 mil.)
Sometimes Eligible (43 mil.)
Multiple routes
Welfare only
16%
SCHIP
only
24%
Poverty
only
16%
59%
51%
28%
6%
SCHIP only <1%
Poverty
only
Welfare only
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.)
Eligible for
SCHIP
Not Eligible
for SCHIP
64%
EVER SCHIP Eligible (25 mil.)
Not eligible
for Medicaid
Eligible for
Medicaid
27%
36%
73%
32% of all eligible children were eligible for both Medicaid and SCHIP.
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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
Not eligible for
Medicaid
Eligible in all
waves
17%
32%
68%
42%
40%
Eligible for
Medicaid
in some
prior wave
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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
Medicaid or SCHIP
46%
(any)
Always
Eligible
Sometimes
Eligible
81%
30%
Private Insurance
(any)
Uninsured in ANY
eligible wave
66
36
78
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 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
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POLICY IMPLICATIONS - 2
• Uninterrupted eligibility might not be sufficient
to protect children from disruptions in
coverage
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