Analysis of Children's Health Insurance Patterns: Findings from the SIPP. 3. Medicaid-Eligible Uninsurance

05/12/1999

The large number of uninsured children who appear to be eligible for Medicaid has captured the attention of policymakers and advocacy groups alike. In Technical Appendix A we present estimates that 30 to 33 percent of the children who were uninsured at a point in time in FY93 or FY94 were eligible for Medicaid, based on an eligibility simulation that accounted for a substantial majority but certainly not all Medicaid-eligible children. Here we ask how long children who are uninsured and eligible for Medicaid tend to remain both uninsured and Medicaid-eligible.

Table 4 provides information on the duration of spells of Medicaid-eligible uninsurance. A spell of Medicaid-eligible uninsurance begins in the first month that a child is both uninsured and Medicaid-eligible. A child may have been uninsured for one or more months before becoming Medicaid-eligible or may have been Medicaid-eligible at the start of a spell of uninsurance. Likewise, a child may have lost Medicaid eligibility before becoming insured or may have remained eligible through the end of a spell of uninsurance.4 Because patterns may vary, we cannot infer the full length of a spell of uninsurance from the number of months that a child was both Medicaid eligible and uninsured.

TABLE 4: SPELLS OF MEDICAID-ELIGIBLE UNINSURANCE STARTING IN FY93 BY COMPLETED DURATION
  Spells Starting 11/92 to 9/93 Spells Starting 11/92 to 3/93
Completed Duration of Spell Number Percent Cumulative Percent Number Percent Cumulative Percent
All Spells 6,814,000 100   3,161,000 100  
1 Month 1,801,000 26.4 26.4 819,000 25.9 25.9
2 Months 1,140,000 16.7 43.2 496,000 15.7 41.6
3 Months 708,000 10.4 53.5 344,000 10.9 52.5
4 Months 1,450,000 21.3 74.8 634,000 20.1 72.6
5 Months 293,000 4.3 79.1 179,000 5.7 78.2
6 Months 188,000 2.8 81.9 104,000 3.3 81.5
7 Months 79,000 1.2 83 38,000 1.2 82.7
8 Months 295,000 4.3 87.4 155,000 4.9 87.6
9 Months 56,000 0.8 88.2 6,000 0.2 87.8
10 Months 81,000 1.2 89.4 42,000 1.3 89.1
11 Months 46,000 0.7 90.1 34,000 1.1 90.2
12 Months 255,000 3.7 93.8 77,000 2.4 92.6
13+ Months 422,000 6.2 100 233,000 7.4 100
13 Months       11,000 0.4 93
14 Months       26,000 0.8 93.8
15 Months       8,000 0.3 94.1
16 Months       51,000 1.6 95.7
17 Months       0 0 95.7
18 Months       24,000 0.7 96.4
19+ Months       112,000 3.6 100
SOURCE: Survey of Income and Program Participation, 1992 Panel.

We began our Medicaid-eligibility simulation in October 1992, so we cannot identify new spells of Medicaid-eligible uninsurance starting before November 1992. (We need to observe the previous month to determine if a new spell has started.) The spells reported in Table 4, therefore, began in November 1992 or any of the subsequent months through September 1993.

Spells of Medicaid-eligible uninsurance tend to be much shorter than spells of uninsurance generally. More than one-half of all spells started in FY93 were completed in three months or less, and only 6 percent extended beyond one year. Among all spells of uninsurance started during the same period, 20 percent reached beyond one year, and more than 15 percent extended at least another six months beyond that.

Finally, the SIPP seam effect is much less pronounced for spells of Medicaid-eligible uninsurance than for all spells of uninsurance. We attribute this to the fact that simulated Medicaid- eligibility is not a characteristic that is reported by survey respondents or recorded by survey interviewers but a complex construct of a great many variables that change at different rates and times. Nevertheless, there are local peaks at four, eight, and 12 months. Taking this into account suggests that the proportion of spells of Medicaid-eligible uninsurance completed in three months or less could be as high as 60 percent.

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