Analysis of Children's Health Insurance Patterns: Findings from the SIPP. 2. Spells of Medicaid-Eligible Uninsurance

05/12/1999

A spell of uninsurance in which a child is eligible for Medicaid can begin or end with the child losing Medicaid eligibility without regaining insurance coverage. Table 6 presents cross-tabulations of coverage before and after spells of Medicaid-eligible uninsurance, but it differs from Table 5 in that it includes uninsurance without Medicaid eligibility as a status before and after a spell.

Nearly one-half of children who experienced spells of Medicaid-eligible uninsurance lasting 12 months or less were uninsured but ineligible for Medicaid before beginning their spells, and 31 percent left spells of Medicaid-eligible uninsurance by losing their Medicaid eligibility. Medicaid enrollment preceded 27 percent of the spells of Medicaid-eligible uninsurance and followed 31 percent of them. Only 19 percent of children who experienced spells of Medicaid-eligible uninsurance were covered by employer-sponsored insurance immediately prior to their spells, and just under 15 percent gained employer-sponsored coverage to end their spells. Uninsurance without Medicaid-eligibility bracketed 34 percent of the 1 to 12 month spells of Medicaid-eligible uninsurance while actual Medicaid enrollment bracketed 16 percent of the spells. Employer- sponsored coverage preceded and followed only 6 percent of spells.

As we have seen, spells of Medicaid-eligible uninsurance tend to be quite short, so the spells completed in 12 months or less are dominated by spells completed in 1 to 4 months. The pattern of coverage before and after spells of Medicaid-eligible uninsurance changes dramatically as the duration of these spells increases. Until durations of 13 months or longer the changes are largely confined to the distribution of coverage prior to the spell of Medicaid-eligible uninsurance. Medicaid enrollment becomes more important than Medicaid ineligibility, accounting for more and more of the coverage prior to such spells. Among spells completed in 13 to 18 months, 43 percent began with children leaving Medicaid enrollment compared to 31 percent that started with uninsured children becoming Medicaid-eligible. The reverse trend occurred for the source of coverage following a spell of Medicaid-eligible uninsurance, although there are minimal changes between spells of 1 to 4 month duration and spells of 9 to 12 month duration. Among the longer spells, 65 percent ended with children losing Medicaid eligibility but remaining uninsured. Only 6 percent of the children gained employer-sponsored coverage while 29 percent enrolled in Medicaid.

TABLE 6: INSURANCE COVERAGE BEFORE AND AFTER COMPLETED SPELLS OF MEDICAID- ELIGIBLE UNINSURANCE BEGINNING IN FY93, BY DURATION OF SPELL
  Insurance Coverage After Completion of Spell
Insurance Coverage Before Start of Spell Employer- sponsored Medicaid Other Uninsured (Med-inel.) Not in Universe
  All Spells Completed in 12 Months or Less
Employer-sponsored 6 4.8 0.2 8.1 0.2
Medicaid 2.4 15.6 0.4 8.4 0.6
Other 0.3 0.4 0 0.6 0
Uninsured (Med-inel.) 5.6 9.2 0.4 34.4 0
Not in Universe 0.4 1.5 0 0.5 0.1
Total 14.7 31.4 1 51.9 0.9
  Spells Completed in 1 to 4 Months
Employer-sponsored 6.3 4.7 0.3 7 0.2
Medicaid 2.1 15 0.2 6.8 0.7
Other 0.1 0.3 0 0.7 0
Uninsured (Med-inel.) 6.1 9.6 0.5 37.5 0
Not in Universe 0.2 1 0 0.6 0.2
Total 14.8 30.5 1 52.6 1.1
  Spells Completed in 5 to 8 Months
Employer-sponsored 5.6 5.4 0 12 0
Medicaid 1.5 19.6 0.7 11.2 0
Other 1.3 0 0 0.6 0
Uninsured (Med-inel.) 6 7.2 0 24.3 0
Not in Universe 1.7 2.9 0 0 0
Total 16.1 35.1 0.7 48.1 0
  Spells Completed in 9 to12 Months
Employer-sponsored 3.3 5.4 0 13.1 0
Medicaid 7.2 14.2 2.1 21.5 0.9
Other 0 2 0 0 0
Uninsured (Med-inel.) 0 8.9 0 17.1 0
Not in Universe 0 4.1 0 0 0
Total 10.6 34.6 2.1 51.8 0.9
  Spells Completed in 13 to 18 Months*
Employer-sponsored 0 0 0 21.1 0
Medicaid 5.9 28.8 0 8.8 0
Other 0 0 0 0 0
Uninsured (Med-inel.) 0 0 0 31.2 0
Not in Universe 0 0 0 4.3 0
Total 5.9 28.8 0 65.3 0

* These spells are limited to those beginning in the first six months of FY93.

SOURCE: Survey of Income and Program Participation, 1992 Panel.

In looking at the combinations of coverage that precede and follow 13 to 18 month spells of Medicaid-eligible uninsurance, we find that 29 percent of these spells are bracketed by Medicaid enrollment and 31 percent are bracketed by uninsurance without Medicaid eligibility. We found no instances of children having employer-sponsored coverage both before and after a spell of Medicaid- eligible uninsurance. All of the children who lost employer-sponsored coverage to become uninsured but eligible for Medicaid ended their spells by losing their Medicaid eligibility rather than enrolling in Medicaid. This is quite different from what we observed with all spells of uninsurance, but we cannot tell from Table 6 what may have happened to these children after losing Medicaid eligibility. Many of them may have gained employer-sponsored coverage, and some could have regained Medicaid eligibility and become enrolled. Finally, in viewing the bottom panel of Table 6 we need to keep in mind that, according to Table 4, these spells account for less than four percent of all spells of Medicaid-eligible uninsurance that began in FY93.

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