Health Care Coverage and Medicaid/CHIP Eligibility for Child Support Eligible Children. Data and Methods

07/30/2011

The main source of data for the analysis is the 2009 Annual Social and Economic Supplement (ASEC) to the Current Population Survey (CPS), representing income and health insurance coverage for 2008.  Because individuals may report multiple types of health insurance coverage on the CPS, we assign one type of coverage to each child based on the following hierarchy: Medicaid/CHIP, employer sponsored insurance coverage (ESI) from inside the household, any coverage from outside the household, other federal coverage (including Tricare, VA and Medicare) and directly purchased coverage from inside the household.[7],[8]  The remaining individuals are categorized as uninsured.  While the CPS includes questions on both Medicaid and CHIP coverage, it is not possible to reliably distinguish between these types of coverage and thus we only present aggregate estimates that combine Medicaid and CHIP.[9]  As indicated above, we provide additional detail on those who report receiving coverage from outside the household.[10]  Estimates of insurance coverage reflect adjustments to account for the underreporting of Medicaid and CHIP on the CPS using a methodology developed for previous analyses.[11]  The adjustments have the effect of reducing the number of uninsured child support eligible children by 0.4 million and the number with private or other public coverage by 0.8 million, while increasing the number with Medicaid/CHIP coverage by 1.2 million.

In this analysis, we interpret the CPS uninsurance estimates as point-in-time, (i.e. average monthly) estimates.  A point-in-time estimate of uninsurance, for instance, will be greater than an estimate of full year uninsurance, but less than an estimate of any uninsurance over the course of a year.  While the CPS is worded with the intention of capturing full year uninsurance estimates, the results have generally been considered to be more closely in line with point-in-time estimates.[12]  However, CPS estimates of individuals who report multiple types of coverage are much higher than point-in-time estimates and likely reflect coverage held at different points during the year for some respondents.[13]  We therefore do not present estimates of dual coverage in our main estimates, but include such estimates in Appendix Table 2.

For this analysis, the child support eligible universe is defined as children 0-18 residing with one biological parent and one step parent or one biological parent only.[14]  In addition, children under 15 living with no biological or adoptive parents are included in the eligible population.[15]  Estimates of income as a percent of poverty reflect the income of the health insurance unit (HIU) and reflect U.S. Census Bureau poverty thresholds.[16]  HIUs are derived from information available on household structure from the CPS, and are used as the family unit of analysis because they more closely align with the family groupings used by states when determining Medicaid/CHIP eligibility than Census households or families.[17]  Estimates of family composition reflect Census family groupings and identify families with one parent, two parents, or multiple generations (e.g. grandparents, parents, children) residing together.[18]  Other living arrangements that do not conform to these categories are also identified.  These may include children living with other relatives or foster children.  Because the CPS is a household survey, CS eligible children cannot be linked to the noncustodial parent (NCP) who does not live in the household.  Therefore, no information on income or insurance coverage for the NCP is available.  However, child support payments made by the NCP are on the custodial parent's CPS record and any insurance coverage from outside the household is noted for each individual on the CPS.  For CS eligible children, this is very likely to be coverage provided by the NCP.

Estimates of Medicaid/CHIP eligibility are based on the Urban Institute’s Health Policy eligibility simulation model.[19]  The model simulates eligibility for Medicaid and CHIP using information on 2008 eligibility guidelines for each program and state, including the amount and extent of disregards.[20]  These guidelines are applied to person and family level data from the CPS to simulate the eligibility determination process.[21]  Because the CPS does not collect information on monthly income, it is not possible to determine how eligibility status changes as a result of income fluctuations throughout the year.  Family-level characteristics used in determining eligibility, such as income, are based on the HIU.  A discussion of the use of the ASEC rather than the CPS Child Support Supplement (CSS) is provided in the appendix.

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