Overlapping Eligibility and Enrollment: Human Services and Health Programs Under the Affordable Care Act. Determination of eligibility and receipt of human services

12/23/2013

Eligibility and receipt of human services were based on TRIM-simulated 2010 eligibility and participation in those benefit programs. With the exception of Unemployment Insurance (which is based on the characteristics and income of an individual), eligibility is determined based on the income and characteristics of a group of people within a household, referred to as the filing unit. TRIM simulates the nuances of whose income is counted and which persons in the unit are eligible for benefits. For example, in SNAP, most lawfully present non-citizens aged 18 or older are generally ineligible for assistance in their first five years in the United States, but their lawful permanent resident or citizen children are eligible. Following SNAP rules, TRIM counts a prorated share of a non-citizen’s income in determining eligibility for his or her children. Whereas the child is counted as eligible for SNAP, the parent is not.

In general, the tables for this report categorize a person as eligible for assistance if he or she is personally eligible (not simply in a unit where someone is eligible). However for three programs, a broader definition of eligibility was used:

  • EITC: If a taxpayer is simulated to be eligible for the EITC, that eligibility is considered to include not just the taxpayer, but also his or her spouse and all children in the household who meet the criteria for an “EITC qualifying child”.
  • Child Care Subsidies: If any children are eligible for subsidies, that eligibility is considered to include the head and spouse of the children’s family, any unmarried parents outside the family (but in the household), and any other family members under 19. Subfamilies are treated as separate families.
  • WIC: If any child (or pregnant woman) is eligible for WIC, that eligibility is considered to include the head and spouse of the family, any unmarried parents outside the family (but in the household), and any other family members under 19. Subfamilies are treated as separate families.

Note the following about TRIM’s simulation of the following human services programs:

  1. The Unemployment Insurance data for this analysis does not adjust for the under-reporting of UI income in the CPS-ASEC data.
  2. WIC adjunctive eligibility via Medicaid does not include persons who are simulated to be newly-eligible for Medicaid under the ACA. Only persons who report Medicaid on the CPS and TRIM finds eligible for Medicaid in 2010 are considered adjunctively eligible.
  3. The count of individuals who are eligible for WIC includes only people who would be eligible based on that month’s characteristics and family income; it does not include people who would be eligible through continuous enrollment based on enrollment in a prior month.

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