Welfare Leavers and Medicaid Dynamics: Five States in 1995. Did Welfare Leavers Stay on Medicaid?

04/14/2000

A key part of our analysis was to see what happened to the Medicaid status of individuals leaving AFDC. We focused on those who left from February through July 1995, so that we could follow the Medicaid status for six months after AFDC exit. Six months seemed to us a sufficient time to assess whether Medicaid coverage continued. We counted persons as having left AFDC only if they did not receive benefits for two consecutive months. This standard reduced the likelihood of counting persons whose AFDC coverage was interrupted temporarily because of failure to comply with reporting or other administrative requirements.

What proportion of adults who left AFDC stayed on Medicaid? Across the five states, from 49.3 percent (California) to 66.6 percent (Florida) of adults were no longer enrolled in Medicaid three months after leaving AFDC (Table 4). This overall pattern changed very little at the six-month interval. At six months, three of the states had a slight increase in the proportion of adults who were covered by Medicaid, but only because more adults had returned to the AFDC rolls (and were thus automatically reenrolled in Medicaid). Transitional benefits were used by a relatively small proportion of adults in the three states in which data on transitional coverage were available, ranging from 8.4 percent of adults in California to 19.1 percent in New Jersey. By the sixth month after AFDC exit, between 12 percent (New Jersey) and 18.8 percent (California) of adults across the study states had returned to the AFDC program.

  Alabama Arkansas California Florida Michigan New Jersey
TABLE 4
PERCENT DISTRIBUTION OF ADULTS LEAVING AFDC FROM FEBRUARY THROUGH JUNE 1995,
BY THEIR MEDICAID STATUS THREE AND SIX MONTHS AFTER LEAVING AFDC
 
  Three Months After Leaving AFDC
Not Enrolled in Medicaid 59.0 71.8 49.3 66.6 50.0 62.8
Medicaid Enrollment Group            
     Transitional Coverage NAa 17.3 8.4 14.2 NAa 19.1
     Medically Needy -- 1.8 7.6 2.2 7.2 <0.0
     Poverty-related 0.4 1.5 0.3 1.8 1.5 0.2
     SSI 3.9 1.8 2.3 2.7 6.2 1.4
     Other Non-cash 31.0 2.6 22.3[1] 6.0 30.1 12.2
     AFDC Cash 5.7 3.2 9.9 6.5 5.0 4.2
     Subtotal 41.0 28.2 50.7 33.4 50.0 37.2
Total 100.0 100.0 100.0 100.0 100.0 100.0
 
  Six Months After Leaving AFDC
Not Enrolled in Medicaid 60.5 65.2 56.2 64.8 49.1 61.2
Medicaid Enrollment Group            
     Transitional Coverage NAa 13.1 6.1 8.6 NAa 18.9
     Medically Needy -- 2.0 8.6 1.5 5.5 <0.0
     Poverty-related 2.3 1.6 0.3 1.5 1.2 0.3
     SSI 3.8 2.0 2.4 2.8 6.7 1.4
     Other Non-cash 16.8 1.8 7.4b[2] 3.7 24.1 6.2
     AFDC Cash 16.6 14.3 18.8 17.0 13.3 12.0
     Subtotal 39.5 34.8 43.6 35.1 50.8 38.8
Total 100.0 100.0 100.0 100.0 100.0 100.0
 
  (n = 16,432) (n = 9,137) (n = 170,726) (n = 98,717) (n = 28,692) (n = 24,544)

Source: SMRF Data

NA - Not available

aIn Alabama and Michigan, persons qualifying for Medicaid under the transitional coverage provisions could not be separately identified.  For these two states, persons with transitional coverage are included under the Other Non-Cash group.

bIncludes court-ordered Edwards v. Kizer group for California, which allows families leaving welfare to remain on Medicaid until their eligibility under other coverage provisions can be redetermined.

* Includes court-ordered Edwards v. Kizer group for California which allows families leaving welfare to remain on  Medicaid until their eligibility under other coverage provisions can be redetermined.


[1]
David Ellwood:
[2]
David Ellwood:

As we expected, children leaving AFDC were more likely than their parents to remain on Medicaid (Table 5). The margin of difference, however, was not large, except in Florida. Three months after leaving AFDC, the proportion of children not enrolled in Medicaid ranged from 46.7 percent (California) to 57.9 percent (Florida) across the five states. Similar to adults, the situation improved somewhat by the sixth month, but only because more children had returned to the AFDC program. The eligibility groups used to continue coverage varied across the states. California and New Jersey were less likely to use the poverty-related provisions to continue child coverage after AFDC than the other study states. However, it is difficult to compare the states on the basis of which eligibility groups they used to continue Medicaid eligibility. For example, California’s medically needy income threshold was considerably higher than the AFDC threshold, so that more children could qualify under the medically needy provisions, before they were tested for coverage under the poverty-related group. If California's medically needy income threshold had been closer to the AFDC threshold, more children would likely have qualified under the poverty-related provisions.

Thus, in all the study states, close to half or more of children and their parents who left welfare in 1995 also left Medicaid. We cannot be certain what happened to the insurance status of each of these individuals; however, previous research suggests that many became uninsured. In addition, it seems likely that the vast majority of children could have retained their Medicaid eligibility, given the poverty-related provisions available in all the states.

  Alabama Arkansas California Florida Michigan New Jersey
TABLE 5
PERCENT DISTRIBUTION OF CHILDREN LEAVING AFDC FROM FEBRUARY THROUGH JUNE 1995,
BY THEIR MEDICAID STATUS THREE AND SIX MONTHS AFTER LEAVING AFDC
 
  Three Months After Leaving AFDC
Not Enrolled in Medicaid 55.7 64.3 46.7 49.8 46.9 57.9
Medicaid Enrollment Group          
     Transitional Coverage NAa 19.4 7.4 15.0 NAa 16.9
     Medically Needy -- 2.6 8.4 0.8 10.6 <0.0
     Poverty-related 0.7 5.7 0.9 18.0 9.7 1.5
     SSI 3.5 1.1 1.4 1.9 <0.0 1.3
     Other Non-cash 35.3 3.5 23.4b 7.7 27.5 18.4
     AFDC Cash 4.8 3.5 12.0 7.0 5.3 3.9
     Subtotal 44.3 35.7 53.3 50.2 53.1 42.1
Total 100.0 100.0 100.0 100.0 100.0 100.0
 
  Six Months After Leaving AFDC
Not Enrolled in Medicaid 55.1 56.2 51.0 48.2 44.1 56.9
Medicaid Enrollment Group          
     Transitional Coverage NAa 14.2 5.3 9.0 NA 16.4
     Medically Needy -- 3.0 9.4 0.6 8.8 <0.0
     Poverty-related 7.1 7.1 1.4 15.6 10.1 2.2
     SSI 3.7 1.2 1.4 2.1 0.1 1.3
     Other Non-cash 20.5 2.5 10.2b 5.6 22.2 11.4
     AFDC Cash 13.7 15.9 21.3 19.0 14.8 11.8
     Subtotal 45.0 43.9 49.0 51.9 56.0 43.1
Total 100.0 100.0 100.0 100.0 100.0 100.0
 
  (n = 30,676) (n = 20,886) (n = 268,897) (n = 170,161) (n = 85,891) (n = 42,655)

Source: 1995 State Medicaid Research File data.

NA - Not available

aIn Alabama and Michigan, persons qualifying for Medicaid under the transitional coverage provisions could not be separately identified.  For these two states, persons with transitional coverage are included under the Other Non-Cash group.

bIncludes court-ordered Edwards v. Kizer group for California, which allows families leaving welfare to remain on Medicaid until their eligibility under other coverage provisions can be redetermined.

* Includes court-ordered Edwards v. Kizer group for California which allows families leaving welfare to remain on  Medicaid until their eligibility under other coverage provisions can be redetermined.