State Estimates of Uninsured Children, January 1998. Final Report.. E. Illustrative Estimates of Uninsured Children Eligible for Medicaid and SCHIP

05/17/2000

Development of the model-based estimation procedures employed here was motivated by an interest in applying the methodology of microsimulation to individual states. Microsimulation is particularly useful for estimating the incremental impact of small changes in program eligibility on caseloads and costs, but it requires a very large sample.7 To illustrate the application of microsimulation to the reweighted March 1998 database, we have prepared a simulation of eligibility under both Medicaid (1997 rules) and SCHIP (September 1999 rules) and applied this simulation model to the reweighted data. The simulation program captures most of the major elements of state differentiation in income eligibility limits by age, the use of gross versus net income, and, to some degree, the application of asset tests.8 We base eligibility on annual family income rather than trying to construct monthly income streams that would allow a more literal replication of the Medicaid eligibility determination. This is a widely-used practice--in large part because the CPS and other major surveys collect only annual income data. Furthermore, given that the CPS provides only annual rather than monthly estimates of insurance coverage, basing eligibility on simulated monthly rather than reported annual income would not solve the problem of relating eligibility to insurance coverage.

The first four columns of Table I.3 present state estimates of the number of uninsured children, the number of all children who were simulated to be eligible for Medicaid (without regard to insurance coverage), and both the number and percentage of these Medicaid-eligible children who were reported as uninsured. The final three columns present estimates of children who were simulated to be eligible for either Medicaid or SCHIP (again without regard to insurance coverage) and the number and percentage of these Medicaid/SCHIP-eligible children who were uninsured. Medicaid eligibility is based on program rules that were in effect in 1997 while SCHIP eligibility is based on state program provisions that were in effect in September 1999. Thus SCHIP eligibility is prospective or hypothetical rather than actual eligibility in 1997. It should be noted as well that even in the absence of SCHIP, Medicaid eligibility would have grown between 1997 and 1999. Earlier reforms extended eligibility to low income children who were born after September 30, 1983. As these children age, a larger and larger share of all children are made eligible by these provisions.

State Number
Uninsured
All
Simulated
Medicaid
Eligible
Simulated
Medicaid
Eligible But
Uninsured
Percent
Medicaid
Eligible But
Uninsured
All
Simulated
Medicaid
or SCHIP
Eligible
Simulated
Medicaid
or SCHIP
Eligible But
Uninsured
Percent
Medicaid
or SCHIP
Eligible But
Uninsured

TABLE I.3
STATE ESTIMATES OF UNINSURED, MEDICAID-ELIGIBLE, AND SCHIP-ELIGIBLE CHILDREN

U.S. Total 11,452,600 19,329,700 4,249,500 22.0 27,953,400 6,599,900 23.6
Alabama 195,300 292,900 64,800 22.1 532,600 141,000 26.5
Alaska 22,500 38,500 7,900 20.5 82,400 15,300 18.6
Arizona 300,500 377,500 123,000 32.6 633,200 208,800 33.0
Arkansas 164,800 197,300 58,400 29.6 213,600 65,100 30.5
California 1,893,100 3,077,600 732,200 23.8 4,649,300 1,261,200 27.1
Colorado 156,900 193,800 43,000 22.2 314,300 77,500 24.7
Connecticut 81,700 193,200 32,100 16.6 359,900 53,600 14.9
Delaware 21,900 40,100 7,600 19.0 64,300 13,000 20.2
District of Columbia 18,500 47,000 7,600 16.2 65,000 13,800 21.2
Florida 772,300 1,053,600 319,700 30.3 1,762,100 552,600 31.4
Georgia 320,400 614,700 144,100 23.4 946,300 230,800 24.4
Hawaii 29,200 95,800 8,300 8.7 103,600 9,300 9.0
Idaho 70,000 79,800 24,200 30.3 117,600 38,400 32.7
Illinois 401,500 778,500 151,900 19.5 943,800 206,500 21.9
Indiana 186,200 305,100 69,300 22.7 377,100 88,600 23.5
Iowa 78,100 143,000 16,400 11.5 251,400 36,700 14.6
Kansas 83,800 142,200 26,300 18.5 246,400 48,900 19.8
Kentucky 150,300 302,800 59,000 19.5 468,000 95,600 20.4
Louisiana 282,700 380,300 108,100 28.4 492,600 159,000 32.3
Maine 36,600 77,700 13,300 17.1 110,900 18,700 16.9
Maryland 162,400 252,300 60,800 24.1 411,300 104,800 25.5
Massachusetts 140,600 304,000 41,700 13.7 439,700 65,500 14.9
Michigan 252,000 730,100 115,400 15.8 946,400 153,000 16.2
Minnesota 92,100 222,400 15,600 7.0 247,800 17,800 7.2
Mississippi 166,200 262,900 64,300 24.5 292,200 77,900 26.7
Missouri 186,700 367,000 66,500 18.1 884,300 146,100 16.5
Montana 40,300 56,800 12,400 21.8 81,300 19,900 24.5
Nebraska 48,900 86,400 9,000 10.4 151,600 21,500 14.2
Nevada 86,000 100,700 31,700 31.5 175,000 56,800 32.5
New Hampshire 23,900 80,200 8,200 10.2 143,200 14,800 10.3
New Jersey 317,100 403,100 97,800 24.3 643,400 172,000 26.7
New Mexico 102,500 287,900 64,300 22.3 328,000 73,300 22.3
New York 752,700 1,416,200 267,700 18.9 2,060,400 470,800 22.8
North Carolina 314,800 531,700 130,100 24.5 859,200 213,300 24.8
North Dakota 20,500 36,600 5,100 13.9 38,200 5,500 14.4
Ohio 347,300 608,500 107,000 17.6 829,400 161,200 19.4
Oklahoma 179,400 234,100 64,200 27.4 349,800 94,900 27.1
Oregon 128,800 211,600 59,900 28.3 273,200 77,400 28.3
Pennsylvania 288,900 619,900 86,500 14.0 928,200 125,300 13.5
Rhode Island 18,200 106,300 11,300 10.6 124,300 13,000 10.5
South Carolina 170,900 253,600 62,700 24.7 340,000 94,100 27.7
South Dakota 19,700 50,500 5,300 10.5 55,900 6,500 11.6
Tennessee 141,000 362,500 30,700 8.5 408,200 37,400 9.2
Texas 1,517,400 1,771,700 562,100 31.7 2,023,900 678,200 33.5
Utah 99,500 145,500 33,800 23.2 250,900 57,100 22.8
Vermont 9,100 55,400 3,300 6.0 85,400 5,700 6.7
Virginia 232,500 397,700 87,000 21.9 564,000 125,100 22.2
Washington 150,600 515,000 83,800 16.3 676,600 101,700 15.0
West Virginia 53,300 140,400 20,100 14.3 169,500 25,600 15.1
Wisconsin 102,600 259,900 18,300 7.0 401,100 40,700 10.1
Wyoming 20,400 27,400 5,700 20.8 36,600 8,600 23.5
SOURCE: Mathematica Policy Research, from the March 1998 CPS and other sources.

Across all of the states, our estimates of uninsured children who were eligible for Medicaid total 4.2 million out of the 11.5 million uninsured children under 19. Our simulation of SCHIP eligibility suggests that SCHIP would have extended eligibility for public insurance coverage to about 2.4 million additional children.

The estimated percentage of simulated Medicaid-eligible children who were uninsured in each state helps us to understand the patterns of uninsurance among low income children that we saw in Table I.2. Nationally, 22.0 percent of our simulated Medicaid-eligible children were uninsured. Among the states, this rate varies from a low of 7 percent (Minnesota and Wisconsin) to a high of 33 percent (Arizona). Generally, states with higher uninsured rates among children under 100 percent of poverty than among children between 100 and 150 percent of poverty have high rates of Medicaid-eligible uninsured in Table I.3. For example, Arizona, Florida, and Idaho have higher uninsured rates in the two lowest poverty classes than in the 100 to 150 percent class, and all three have Medicaid-eligible uninsured rates in excess of 30 percent. At the other end of the distribution, we singled out Hawaii, Minnesota, Vermont, and Wisconsin for their relatively low uninsured rates among children below 100 percent of poverty, and all four of these have Medicaid-eligible uninsured rates below 10 percent.

Some important implications of the impact of SCHIP eligibility at the state level can be seen in Table I.4, which shows by state the number of uninsured children who were not simulated to be Medicaid-eligible and both the number and percentage of these who would be made eligible for coverage under SCHIP. Nationally, SCHIP would extend eligibility to about one-third of the uninsured children who were not otherwise eligible for Medicaid in 1997. This varies substantially by state--in part because some states were already covering a large part of the population that other states would now cover under SCHIP. Hawaii and Minnesota, which provide broad coverage under Medicaid, would extend coverage to fewer than 5 percent of the uninsured who were not eligible for Medicaid, whereas Alabama, with comparatively low Medicaid coverage, would extend coverage through SCHIP to nearly 60 percent of its remaining uninsured children. At the same time, Texas with comparatively low Medicaid coverage would extend coverage through SCHIP to only 12 percent of its remaining uninsured children while DC would extend coverage to 57 percent.

TABLE I.4
UNINSURED CHILDREN TO WHOM HEALTH INSURANCE COVERAGE MAY BE EXTENDED BY SCHIP

State Uninsured Who are Not
Simulated Medicaid Eligible
Number of These Who are
Eligible for SCHIP
Percent Eligible for SCHIP
U.S. Total 7,203,100 2,350,400 32.6
Alabama 130,500 76,200 58.4
Alaska 14,600 7,400 50.7
Arizona 177,500 85,800 48.3
Arkansas 106,400 6,700 6.3
California 1,160,900 529,000 45.6
Colorado 113,900 34,500 30.3
Connecticut 49,600 21,500 43.3
Delaware 14,300 5,400 37.8
District of Columbia 10,900 6,200 56.9
Florida 452,600 232,900 51.5
Georgia 176,300 86,700 49.2
Hawaii 20,900 1,000 4.8
Idaho 45,800 14,200 31.0
Illinois 249,600 54,600 21.9
Indiana 116,900 19,300 16.5
Iowa 61,700 20,300 32.9
Kansas 57,500 22,600 39.3
Kentucky 91,300 36,600 40.1
Louisiana 174,600 50,900 29.2
Maine 23,300 5,400 23.2
Maryland 101,600 44,000 43.3
Massachusetts 98,900 23,800 24.1
Michigan 136,600 37,600 27.5
Minnesota 76,500 2,200 2.9
Mississippi 101,900 13,600 13.3
Missouri 120,200 79,600 66.2
Montana 27,900 7,500 26.9
Nebraska 39,900 12,500 31.3
Nevada 54,300 25,100 46.2
New Hampshire 15,700 6,600 42.0
New Jersey 219,300 74,200 33.8
New Mexico 38,200 9,000 23.6
New York 485,000 203,100 41.9
North Carolina 184,700 83,200 45.0
North Dakota 15,400 400 2.6
Ohio 240,300 54,200 22.6
Oklahoma 115,200 30,700 26.6
Oregon 68,900 17,500 25.4
Pennsylvania 202,400 38,800 19.2
Rhode Island 6,900 1,700 24.6
South Carolina 108,200 31,400 29.0
South Dakota 14,400 1,200 8.3
Tennessee 110,300 6,700 6.1
Texas 955,300 116,100 12.2
Utah 65,700 23,300 35.5
Vermont 5,800 2,400 41.4
Virginia 145,500 38,100 26.2
Washington 66,800 17,900 26.8
West Virginia 33,200 5,500 16.6
Wisconsin 84,300 22,400 26.6
Wyoming 14,700 2,900 19.7
SOURCE: Mathematica Policy Research, from the March 1998 CPS and other sources.

Table I.5 summarizes the coverage of children under 200 percent of poverty by state, breaking down the low income population into those with insurance, those who were uninsured but eligible for Medicaid in 1997, those who were uninsured and not Medicaid-eligible in 1997 but would be eligible for Medicaid or SCHIP by the rules that were in effect in September 1999, and those who would remain uninsured.9 In the final column we see that three states would leave more than 10 percent of their low income children uninsured and ineligible for Medicaid or SCHIP: Arkansas (16 percent), Mississippi (11 percent), and Texas (13 percent).10 Most states, however, would leave fewer than 2 percent of their low income children uninsured and ineligible for Medicaid or SCHIP.

TABLE I.5
STATE COVERAGE OF CHILDREN UNDER 200 PERCENT OF POVERTY

State Number of Children
Under 200% of Poverty
Percentage of Children Under 200% of Poverty Who Are:
Insured Uninsured
But Medicaid
Eligible
(1997)
Uninsured
But Future Medicaid
or SCHIP Eligible
(1999)
Residual
Uninsured
U.S. Total 31,218,900 75.4 13.5 7.2 3.8
Alabama 541,200 73.0 12.0 14.0 1.1
Alaska 60,200 78.6 13.0 8.1 0.3
Arizona 649,700 66.0 18.9 13.1 1.9
Arkansas 399,100 67.7 14.6 1.7 16.0
California 4,733,500 72.0 15.4 11.1 1.5
Colorado 374,900 75.4 11.5 9.2 4.0
Connecticut 221,500 82.3 14.0 2.9 0.7
Delaware 64,900 79.4 11.6 8.3 0.8
District of Columbia 65,100 78.3 11.7 9.5 0.5
Florida 1,792,800 67.9 17.8 12.9 1.5
Georgia 957,100 75.1 15.0 9.0 1.0
Hawaii 122,000 90.1 6.1 0.6 3.2
Idaho 163,500 69.5 14.8 8.7 7.0
Illinois 1,329,400 77.2 11.4 4.1 7.3
Indiana 512,400 77.7 13.5 3.8 5.0
Iowa 284,200 85.1 5.7 7.1 2.1
Kansas 251,400 79.8 10.5 8.8 0.9
Kentucky 475,900 79.3 12.3 7.6 0.8
Louisiana 670,800 68.7 16.1 7.6 7.6
Maine 125,900 83.2 10.5 4.3 2.1
Maryland 413,700 73.9 14.6 10.5 1.0
Massachusetts 446,400 84.7 9.3 5.2 0.8
Michigan 958,400 83.5 12.0 3.8 0.7
Minnesota 400,200 90.0 3.7 0.3 6.1
Mississippi 454,000 71.5 14.1 3.0 11.3
Missouri 602,200 80.8 11.0 7.8 0.5
Montana 113,900 76.1 10.9 6.6 6.4
Nebraska 172,100 85.4 5.2 7.3 2.1
Nevada 179,000 66.7 17.7 13.9 1.7
New Hampshire 80,300 89.5 9.6 0.6 0.2
New Jersey 651,700 72.6 14.9 11.2 1.3
New Mexico 295,400 76.9 21.3 0.8 1.0
New York 2,152,200 76.4 12.4 9.4 1.8
North Carolina 871,200 74.7 14.9 9.4 1.0
North Dakota 65,800 83.4 7.8 0.6 8.2
Ohio 1,138,300 81.3 9.4 4.8 4.6
Oklahoma 441,700 78.7 14.5 7.0 0.0
Oregon 353,800 72.9 16.9 4.9 5.3
Pennsylvania 1,096,900 86.0 7.8 3.5 2.7
Rhode Island 87,800 87.7 10.8 0.9 0.6
South Carolina 445,100 73.5 14.0 7.1 5.4
South Dakota 85,800 87.1 6.2 1.4 5.4
Tennessee 656,700 88.1 4.6 1.0 6.2
Texas 3,082,400 64.9 18.2 3.8 13.1
Utah 256,300 77.0 13.2 8.9 0.9
Vermont 54,300 95.2 4.1 0.9 0.0
Virginia 622,700 77.6 14.0 6.1 2.3
Washington 529,200 83.3 14.9 1.3 0.5
West Virginia 229,600 84.9 8.8 2.4 4.0
Wisconsin 428,300 89.2 4.0 5.2 1.6
Wyoming 58,000 78.1 9.8 5.0 7.1
SOURCE: Mathematica Policy Research, from the March 1998 CPS and other sources.