Table 2A shows the number of persons ever enrolled in Medicaid during 1999 (column 13), and the duration of enrollment during 1999 (columns 1-12) by eligibility group. Individuals were included in the eligibility group under which they were enrolled for the longest time during the year. That is, if an individual was enrolled under the medically needy child group for three months and under the poverty-related child group for six months, the full nine months of enrollment for that individual was counted in the poverty-related child group. Table 2B converts the data in Table 2A to a percent distribution.
For many years, CMS has reported the number of persons ever enrolled during the year by Medicaid eligibility group (column 13), so this type of information is not new. However, using this information in conjunction with the monthly enrollment data in Table 1 is new and allows CMS to calculate a lower bound estimate of turnover in Medicaid enrollment across states and across eligibility groups.1 Enrollment at the end of the year in December (from Table 1) can be compared to the number of people ever enrolled during the year (column 13 of Table 2) to measure the rate at which people have departed the program and to determine the extent to which this rate varied by eligibility group and/or by state. In recent years, turnover has become a major concern, particularly for children. Research has shown that many uninsured children who appeared to be Medicaid eligible, were previously enrolled in Medicaid, but no longer are participating. With MSIS data, analysts now have some information for determining the extent to which turnover is occurring among eligibility groups across states.
Information on enrollment duration during the year is also new, but these data have to be interpreted with caution. The distribution of enrollment durations could be skewed if there was substantial growth in an eligibility group during the year. For example, a very low proportion of the 1115 adult group (group 55) was enrolled all 12 months of 1999 because the size of the group almost doubled at year end. It is also better to measure enrollment duration over a longer time period, since individuals can have enrollment spells that last many years. Nevertheless, these data provide useful information when used appropriately.
About 42.7 million persons were ever enrolled in Medicaid at any point during 1999, compared to the December, 1999 enrollment level of 34 million. Thus, 8.7 million individuals were enrolled in Medicaid at some point in 1999, who were no longer enrolled at year end.
In 1999, 21.4 million children were enrolled at some point during the year, with 16.7 million enrolled at year end. This means 4.7 million children were enrolled in Medicaid during 1999, but had lost enrollment by year end. The children who lost enrollment represent about 22 percent of those ever enrolled during the year, providing a measure of program turnover. This level of turnover is not necessarily inappropriate. Some children who leave Medicaid "age out" of eligibility. Others leave Medicaid because family income exceeds the Medicaid financial standards. In addition, some children leaving Medicaid become eligible for separately administered State Children Health Insurance Programs (SCHIP), or they become privately insured. However, given that many uninsured children are reported to be Medicaid eligible but not enrolled, a state with a relatively high rate of turnover for children may want to investigate whether some children may be disenrolled from Medicaid inappropriately.
Using this same measure of turnover, 15 percent of the aged lost enrollment during the year. Previous research suggests that, once enrolled, the majority of the elderly remain on Medicaid until death. Persons who were disabled had the lowest turnover rate, with only 9 percent of those ever enrolled in 1999 no longer enrolled at year end.
The highest turnover rate occurred with adults, the eligibility group encompassing parents, caretaker relatives and pregnant women. About 28 percent of adults enrolled during the year were not enrolled at year end.
About 55 percent of those ever enrolled during the year, or 23.5 million individuals, were enrolled in Medicaid in all 12 months of 1999.
Aged and disabled individuals receiving SSI benefits (groups 11 and 12) were enrolled longer during the year than any other eligibility group, with about 85 percent of eligibles remaining enrolled in Medicaid the entire year.
The poverty-related adult group, which includes pregnant women (group 35) was enrolled for the least amount of time over the year, with only about 16 percent of eligibles remaining enrolled the entire year. This is not unexpected, since women in this group are generally only enrolled in Medicaid from a few months into pregnancy through 60 days postpartum.
In general, disabled and aged persons were enrolled for longer than were persons in the child and adult groups in 1999. The four summary rows at the bottom of the table show that persons in the disabled groups were enrolled the longest of any group during 1999: 79 percent of disabled persons were enrolled all 12 months, compared to 72 percent of persons in the aged group. In contrast, about 52 percent of children and 36 percent of adults were enrolled the entire year. However, the duration of child enrollment was effectively reduced by newborns, while the duration of adult enrollment was reduced by pregnant women and the year end addition of the large 1115 group in California that was enrolled for only one month in 1999.
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