THE URBAN INSTITUTE Preliminary: Not for Quotation or Distribution Dynamics of Medicaid and SCHIP Eligibility Among Children: 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 Preliminary: Not for Quotation or Distribution Studies Estimating Change in Share of Children Eligible for Public Programs Study Data Period Increase Lo Sasso & CPS to 41% Buchmueller (2004) Selden et al. (2004) MEPS to 47% Dubay et al. (2005) NSAF to 48%

THE URBAN INSTITUTE Preliminary: Not for Quotation or Distribution RESEARCH OBJECTIVE 1)To describe childrens eligibility patterns for Medicaid and SCHIP over the four-year period )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

THE URBAN INSTITUTE Preliminary: Not for Quotation or Distribution 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

THE URBAN INSTITUTE Preliminary: Not for Quotation or Distribution Methods (1) Eligible waves classified by route of eligibility: 1) Welfare-related Medicaid eligible via AFDC/TANF Section ) Poverty-related Medicaid eligible via Expansions above Section 1931 Section 1115 waiver Medically Needy 3) SCHIP-eligible

THE URBAN INSTITUTE Preliminary: Not for Quotation or Distribution 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

THE URBAN INSTITUTE Preliminary: Not for Quotation or Distribution Share of Children Eligible for Medicaid/SCHIP % 46% SCHIP Begins

THE URBAN INSTITUTE Preliminary: Not for Quotation or Distribution Share of All Children Eligible for Medicaid/SCHIP (58.9 million eligible) 66%

THE URBAN INSTITUTE Preliminary: Not for Quotation or Distribution Comparison of Always, Sometimes, and Never Eligible Child Populations InfantParent Age <25 Less than 100% FPL One Parent or No Parent Always eligible

THE URBAN INSTITUTE Preliminary: Not for Quotation or Distribution Number of Spells of Eligibility Among Sometimes Eligible Children (43 million children) 56%

THE URBAN INSTITUTE Preliminary: Not for Quotation or Distribution Eligibility Routes Over Course of Panel for Always and Sometimes Eligible Children Always Eligible (15.9 mil.)Sometimes Eligible (43 mil.) 53% of all eligible children were eligible through more than one route. Multiple routes SCHIP only Poverty only Welfare only Poverty only Welfare only SCHIP only <1%

THE URBAN INSTITUTE Preliminary: Not for Quotation or Distribution Overlap in Eligibility Between EVER Medicaid and SCHIP Eligible Children 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

THE URBAN INSTITUTE Preliminary: Not for Quotation or Distribution 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* *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

THE URBAN INSTITUTE Preliminary: Not for Quotation or Distribution 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) Uninsured in ANY eligible wave Uninsured in ALL eligible waves 768

THE URBAN INSTITUTE Preliminary: Not for Quotation or Distribution SUMMARY The share of children eligible for public coverage increased substantially in , 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

THE URBAN INSTITUTE Preliminary: Not for Quotation or Distribution 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

THE URBAN INSTITUTE Preliminary: Not for Quotation or Distribution POLICY IMPLICATIONS - 2 Uninterrupted eligibility might not be sufficient to protect children from disruptions in coverage