Analysis of Children's Health Insurance Patterns: Findings from the SIPP. B. Medicaid Eligibility and Participation

05/12/1999

The number of uninsured children who appear to be eligible for Medicaid, according to survey estimates, has raised concerns about the adequacy of Medicaid outreach. In Appendix B we presented findings from the 1992 SIPP panel that suggest that: (1) most uninsured children who become eligible for Medicaid remain eligible for very short periods of time, (2) more than two-thirds of all spells of Medicaid-eligible uninsurance are preceded or followed by periods of uninsurance without Medicaid eligibility, and (3) about one-third of spells of Medicaid-eligible uninsurance are preceded and followed by spells of uninsurance without Medicaid eligibility. The often transitory nature of Medicaid eligibility during spells of uninsurance may help to explain why many uninsured children who appear to be eligible for Medicaid do not enroll. In addition, we found that more than 40 percent of spells of Medicaid-eligible uninsurance were preceded or followed by Medicaid enrollment, and perhaps one fifth of such spells were preceded and followed by Medicaid enrollment. In other words, a significant share of Medicaid-eligible uninsured children appear to have initiated their spells of uninsurance by leaving Medicaid or to have ended their spells of Medicaid-eligible uninsurance by enrolling in Medicaid. For the first group, the key policy question is not why these children have not enrolled in Medicaid but, rather, why they left Medicaid. For the second group the key policy question is not why have these children not enrolled in Medicaid but why have they not enrolled sooner. Thus our analysis of the dynamics of uninsurance, Medicaid eligibility, and Medicaid participation suggests that inferences about the inadequacy of Medicaid outreach from the observation that three or four million uninsured children appear to be eligible for Medicaid at any point in time are overly simplistic and may be only partially supported by a closer examination of this population--particularly before and after the period of Medicaid eligibility. In the first subsection below we examine the demographic and socioeconomic characteristics of uninsured children who appear to be eligible for Medicaid, and in the second subsection we look at Medicaid participation rates among all eligible children by their demographic and socioeconomic characteristics.

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