The last aspect of this literature review focuses on what researchers have discovered about the group of uninsured children who appear to be eligible for Medicaid, but not participating. In particular, how do they differ from children who participate in Medicaid? Two overall questions are involved:
- How do the financial and demographic characteristics of these children and their families differ from those of children participating in Medicaid?
- What are the longitudinal characteristics of eligible nonparticipants? How long are they uninsured, and how long are they eligible for Medicaid?
The first question is important in helping determine which groups of children need to be targeted for federal and state outreach efforts to increase health insurance coverage. The second question is important in understanding the dynamics of the uninsured. Family financial situations may fluctuate considerably from month to month, so that children may be uninsured only for short periods of time. Or, some months families may have income so near the eligibility thresholds that they may not realize they are eligible. The Balanced Budget Act of 1997 gave states the option of extending 12-month continuous eligibility to children, but little information has existed to determine what the impact of this option might be. It would be helpful to understand better the events that trigger uninsurance and potential Medicaid eligibility, and how long the spells of uninsurance and Medicaid eligibility last. Unfortunately, little research has focused on these questions.
An article by Blumberg et al. (1997) provided some information on the dynamics of uninsured children eligible for Medicaid but not participating. They used the 1990 SIPP panel to examine the distribution of transitions into Medicaid by previous insurance status and found that 53 percent of those enrolling in Medicaid were previously uninsured while 46 percent were covered by private health insurance. They did not, though, examine whether and how long the previously uninsured that transitioned into Medicaid were eligible for Medicaid.