Welfare Reform/Child Well-Being Administrative Data Linking. Conclusions

06/01/1999

Our analysis finds virtually no support for employment effects on Medicaid utilization by former TANF recipients. The evidence is weak and inconsistent. The substantive differences among pre- and post - employment means is typically .2 claims per person and never exceeds .45 claims when all claim categories are combined. Not surprisedly, few of these differences are statistically significant at the .05 level. Furthermore these insignificant results occur using a technique where undiagnosed violations of underlying statistical assumptions make finding a significant relationship more, rather than less, likely.

More importantly only one specific finding, a decrease in outpatient claims among 18+ year olds is supportive of the employment hypothesis. The magnitude of this difference is not large enough to effect overall claims. Total claims, as well as HIC claims, are instead attributable to aging and differences in the health care needs of 0-5 year olds. It is clear from our analysis of the Medicaid population as a whole, that Medicaid utilization declines as children move from infancy into childhood. This pattern is also found in the SCDSS linked population. In this case, over-all differences in the number of claims are attributable to decrease among 0-5 year olds, particularly through reductions in the number of HIC claims by this group. Thus overall differences in pre- and post- employment Medicaid utilization are an artifact of aging by 0-5 year olds during the time frame of this study.

While the findings for employment effects on Medicaid Utilization are, at best, very weak, it should not be inferred that these relationships do not merit further investigation. This initial study should be supplanted and refined with additional data, and by alternative research designs. A longer time frame might reveal relationships missed by this study. Continued expansion of the Employment Security Commission data set should allow for 18 month pre- and post- periods by early 1999. The results presented here also suggest that a more detailed comparison of the pre- and post- employment SCDSS populations to the general Medicaid populations be in order if only to determine how the SCDSS population differs.

Likewise other analytic strategies should prove useful. For example, the current study focused on controlling for the individual's state of health pre- and post- by examining the same person at each point in time (i.e. matched pairs). This strength brought certain trade-offs such as the inability to control for continuous variables effectively, the inability to use multiple controls, and a lost of statistical robustness. Future studies might use more powerful multivariate techniques coupled with a proxy to control for the health status of the individual.

Table 1.
SCDSS-Medicaid Linked Population
Pre-Employment versus Post-Employment Medicaid Utilization
Claim Type N Mean Std Dev. ANOVA. Results P < 0.05?
HIC
 All ages:     Pre-employment
                   Post-employment
 0-5 years:   Pre-employment
                   Post-employment
 6-17 years: Pre-employment
                   Post-employment
 18 + years: Pre-employment
                   Post-employment
1031
1031
337
337
412
412
282
282
1.42
1.25
1.27
1.02
1.14
1.04
2.01
1.84
3.52
2.85
2.70
2.46
3.21
2.68
4.60
3.40
F value = 3.51, p=0.061

F value = 4.26, p=0.040

F value = 0.48, p=0.487

F value = 0.63, p=0.428

No

Yes

No

No

Outpatient - All
 All ages:     Pre-employment
                   Post-employment
 0-5 years:   Pre-employment
                   Post-employment
 6-17 years: Pre-employment
                   Post-employment
 18 + years: Pre-employment
                   Post-employment
Outpatient - Emergency Room
 All ages:     Pre-employment
                   Post-employment
 0-5 years:   Pre-employment
                   Post-employment
 6-17 years: Pre-employment
                   Post-employment
 18 + years: Pre-employment
                   Post-employment
Non-Emergency Room
 All ages:     Pre-employment
                   Post-employment
 0-5 years:   Pre-employment
                   Post-employment
 6-17 years: Pre-employment
                   Post-employment
 18 + years: Pre-employment
                   Post-employment
1031
1031
337
337
412
412
282
282

1031
1031
337
337
412
412
282
282

1031
1031
337
337
412
412
282
282

1.39
1.19
1.33
1.18
0.94
0.81
2.12
1.75

0.77
0.66
0.83
0.69
0.51
0.44
1.07
0.93

0.62
0.53
0.50
0.49
0.43
0.37
1.06
0.82

2.59
2.05
2.03
2.05
1.65
1.52
3.85
2.55

1.82
1.27
1.35
1.13
1.00
0.87
2.88
1.77

1.56
1.41
1.37
1.64
1.20
1.02
2.07
1.55

F value = 7.53, p=0.006

F value = 1.28, p=0.259

F value = 2.50, p=0.114

F value = 4.13, p=0.043

F value = 5.55, p=0.019

F value = 3.36, p=0.068

F value = 1.18, p=0.179

F value = 1.27, p=0.261

F value = 3.10, p=0.079

F value = 0.01, p=0.907

F value = 1.03, p=0.310

F value = 3.81, p=0.052

Yes

No

No

Yes

Yes

No

No

No

No

No

No

No

HIC + All Outpatient
 All ages:     Pre-employment
                   Post-employment
 0-5 years:   Pre-employment
                   Post-employment
 6-17 years: Pre-employment
                   Post-employment
 18 + years: Pre-employment
                   Post-employment
1031
1031
337
337
412
412
282
282
2.81
2.44
2.60
2.20
2.07
1.86
4.13
3.58
4.79
3.91
3.68
3.48
3.86
3.48
6.59
4.69
F value = 9.30, p=0.002

F value = 4.45, p=0.036

F value = 1.97, p=0.161

F value = 3.28, p=0.071

Yes

Yes

No

No

 

Table 2.
Medicaid - Eligible Children (Ages 0-5 Years)
Care Utilization
Claim Type N Mean Std Dev. ANOVA Results P < 0.05?
HIC
 0-5 years: 1/1/96-12/31/96
                 1/1/97-12/31/97
54644
54644
1.71
1.62
4.37
3.70
F value = 27.56, p=0.0001 Yes
Outpatient - All
 0-5 years: 1/1/96-12/31/96
                 1/1/97-12/31/97
Outpatient - Emergency Room
 0-5 years: 1/1/96-12/31/96
                 1/1/97-12/31/97
Outpatient-Non-Emergency Room
 0-5 years: 1/1/96-12/31/96
                 1/1/97-12/31/97
54644
54644

54644
54644

54644
54644

1.52
1.26

0.85
0.71

0.67
0.56

2.77
2.47

1.37
1.20

2.20
1.98

F value = 652.48, p=0.0001

F value = 602.82, p=0.0001

F value = 213.61, p=0.0001

Yes

Yes

Yes

HIC + All Outpatient
 0-5 years: 1/1/96-12/31/96
                 1/1/97-12/31/97
54644
54644
3.23
2.90
5.61
4.89
F value = 295.14, p=0.0001 Yes