Children's Health Insurance Patterns: A Review of the Literature. A. HOW MANY UNINSURED CHILDREN ARE ELIGIBLE FOR MEDICAID?

12/19/1997

Estimates of the number of uninsured children eligible for but not participating in Medicaid have been undertaken by the following researchers and organizations: The Urban Institute, Reschovsky et al., Thorpe, GAO, and the Center for Budget and Policy Priorities (CBPP). All but Reschovsky et al. used the March CPS for their estimates; Reschovsky et al. used the CTS Household Survey data. These estimates are presented below and summarized in Table IV.1.

 

TABLE IV.1
ESTIMATES OF THE NUMBER OF UNINSURED CHILDREN WHO ARE ELIGIBLE FOR MEDICAID BUT NOT PARTICIPATING, BY SOURCE
Source Data Time Period Estimate Definitions and Eligibility Criteria Uninsured Children Eligible for Medicaid
Number
(millions)
Pct. of All Uninsured
Urban Institute's

TRIM2 Model

(which adjusts for Medicaid undercount)

CPS 3/96 1995 Estimate definition: Children age 17

Eligibility criteria:

State-specific poverty related

AFDC children

SSI children

Medically needy children

Assets

1.6 24%
Reschovsky et al. (1997) CTS late 1996 /

early 1997

Estimate definition: Children age 18.

Eligibility criteria:

State-specific poverty-related criteria only.

3.1 35%
Thorpe (1997b) CPS 3/96 1995 Estimate definition: Children age 18

Eligibility criteria:

None given.

3.3 31%
GAO (1996) CPS 3/95 1994 Estimate definition: Children age 11

Eligibility criteria:

Poverty-related only. Not state-specific. Only includes children age 5 with family incomes below 133% of poverty and children 6-11 with family incomes below 100% of poverty.

2.9 30%
Center for Budget and Policy Priorities (Summer et al. 1997) CPS 3/95 1994 Estimate definition: Children age 10.

Eligibility criteria:

Poverty related only. Not state-specific. Only the federal minimum poverty-related eligibility criteria for children age 10.

2.7 45%

Generally, these estimates showed that the overall number of uninsured children eligible for, but not participating in Medicaid, ranged from 1.6 to 3.3 million during 1995 (24 to 45 percent of all uninsured children). Differences in the estimates appear to vary by data source used, by whether or not adjustments were made to reconcile Medicaid enrollment with Medicaid administrative data, and by the complexity of the simulation method that was used.

1. The Urban Institute

The Urban Institute used March 1996 CPS data to estimate the number of uninsured children age 0 to 17 that were eligible for Medicaid in 1995 but not participating (personal communication with Beth Kessler of The Urban Institute, August 12, 1997). To make the estimate, they used their TRIM2 microsimulation model, which simulates Medicaid eligibility for children on the basis of the following criteria: state-specific poverty related criteria, AFDC and SSI participation, state medically needy programs, and asset eligibility. In addition, the TRIM2 model adjusts for the CPS underreporting of Medicaid enrollment and AFDC and SSI participation, thereby increasing the number of Medicaid enrollees.(3) They found that in 1995, at least 1.6 million (24 percent) of the 6.9 million children classified as uninsured were eligible for Medicaid, but not enrolled.

2. Reschovsky et al.

Reschovsky et al. (1997) used the CTS data to determine how many uninsured children age 0 to 17 were eligible for Medicaid but not enrolled. Reschovsky et al. determined Medicaid eligibility only on the basis of age and family income in relation to each state's poverty-related eligibility standards. Reschovsky et al. cautioned that their eligibility estimates were approximations because of the following limitations in the data and their eligibility algorithm: (1) eligibility under Medicaid is usually based on monthly income while the CTS asked respondents for annual income only; (2) annual income may be subject to recall error; (3) asset eligibility was not taken into account; and (4) medically needy and some other Medicaid provisions were not taken into account. Reschovsky et al. found that 3.2 million (38 percent) of the 8.5 million children uninsured according to the CTS were eligible for Medicaid. In making this estimate, Reschovsky et al. did not adjust the CTS data to account for Medicaid underreporting.

3. Thorpe

Thorpe (1997b), using March 1996 CPS data, estimated that 3.3 million (31 percent) of the 10.5 million uninsured children age 0 to 18 in 1995 were eligible for Medicaid. Thorpe did not describe in any detail his methodology for determining Medicaid eligibility, so it is not clear whether he used state specific income thresholds. Thorpe did not adjust the CPS data to account for Medicaid underreporting.

4. Estimates for Poverty-Related Expansion Children Only

Two organizations, the GAO and CBPP, used the March 1995 CPS to estimate a subset of younger children eligible for but not participating in Medicaid -- only those eligible for Medicaid by federal mandate. This included all uninsured children age 0 to 5 in families with incomes below 133 percent of poverty and uninsured children born after September 30, 1983 with family income below 100 percent of poverty. Both organizations used only the federal minimum income thresholds and did not account for states using higher thresholds.

GAO (1996) estimated that there were 2.9 million uninsured children under age 12 in 1994 who were eligible for Medicaid by federal mandate. CBPP (Summer et al. 1997) also used 1995 CPS data, but their estimate was computed for children under age 11. CBPP found 2.7 million uninsured children under age 11 in 1994 were eligible for Medicaid (45 percent of the 5.9 million uninsured children under age 11).