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Simulation of Medicaid and SCHIP Eligibility: Implications of Findings From 10 States. Final Report.

Publication Date
Aug 15, 2000

By:
Carol Irvin
John Czajka

August 16, 2000

Submitted to:
Office of the Assistant Secretary for Planning and Evaluation
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201

Project Officer:
Sarah Goodell
Robert Stewart

Submitted by:
Mathematica Policy Research, Inc.
50 Church Street, 4th Floor
Cambridge, MA 02138

Project Director:
John Czajka

"

I. Introduction and Summary of Findings

Estimates of the number of children eligible to participate in Medicaid and the State Children's Health Insurance Program (SCHIP), but who remain uninsured, will play an important role in the evaluation of SCHIP's success. There is no single data source that directly tells us how many children are eligible for these programs, however. Rather, estimates of eligibility must be simulated by applying state eligibility rules, household by household, using a survey database that contains measures of the same characteristics a caseworker would record in an actual eligibility determination. To carry out such a simulation, we require knowledge of each state's program rules for determining eligibility, as well as a nationally representative database that provides data on the variables most influential in determining eligibility.

In this report, we present key findings on variations in state eligibility rules across 10 states and discuss the implications for simulations of income eligibility for Medicaid and SCHIP, based on national household survey data. We also assess five national household surveys and their ability to support simulation of Medicaid and SCHIP eligibility.

Mathematica Policy Research, Inc. (MPR) collected detailed information on the rules used in 10 states to determine eligibility for Medicaid and SCHIP--Alabama, Arkansas, California, Colorado, Connecticut, Florida, Massachusetts, Michigan, New Jersey, and New York.1 The data involved four broad topic areas: income standards, income and asset methodologies, family composition rules, and other eligibility rules such as presumptive eligibility and third-party insurance coverage. Information about eligibility rules was collected for the Temporary Assistance for Needy Families (TANF) program, for two Medicaid programs--Section 1931 Medicaid and Medicaid poverty expansions--and the state's SCHIP program. As appropriate, we collected information on the state's SCHIP Medicaid expansion (M-SCHIP) and its state-designed program (S-SCHIP).

Based on the 10 states in our sample, we find that:

  • Income eligibility rules vary considerably across states and across programs within a state.
  • States have used the greater flexibility of the TANF program to introduce a larger variety of earnings disregards. In addition, TANF policies regarding the treatment of unearned income and household expenses vary considerably across states.
  • Some, but not all, 1931 Medicaid programs have adapted TANF income eligibility rules, that provide some degree of uniformity across programs within the state. Medicaid poverty expansion programs, however, continue to use the disregard standards of the old Aid to Families with Dependent Children (AFDC) program when they use a net income test. As a result, income eligibility rules within a state can vary across the TANF, 1931, and poverty expansion programs.2
  • In a further departure from uniformity, the S-SCHIP programs often use less complex rules than the Medicaid programs. Many S-SCHIP programs, for example, use gross income tests, and their family composition rules have fewer exclusions. Because of these differences, important variations have arisen between the Medicaid and S-SCHIP programs within a state and make simulating eligibility for these programs more complex.

While variability in eligibility rules was expected, the level of variability was somewhat surprising. In particular, the relatively common practice of using net income tests in Medicaid programs and gross income tests in S-SCHIP programs has implications for understanding the degree to which SCHIP actually extends coverage for children. To better understand the implications of differences across states and programs, we derived effective income levels for each program in our sample. Using a hypothetical family of three, we determined the maximum amount of earnings after accounting for earnings, child care, and child support disregards the family could have and still qualify the children for benefits under each program. We find that the effective income levels used by TANF and Medicaid 1931 programs vary widely across states. Medicaid poverty expansion programs extend coverage for children in families with income substantially above the levels for the TANF and 1931 programs. The effective income levels for most Medicaid poverty expansion programs are above the mandated levels. Our example also demonstrates that many M-SCHIP programs extend coverage for adolescents, while covering few (if any) additional younger children. We also find that the difference in the effective income levels between the Medicaid poverty and SCHIP programs is less than that suggested by the income thresholds used in income eligibility tests. This is one of several factors that may affect the success of SCHIP programs in covering additional children.

These findings demonstrate that the task of simulating eligibility for SCHIP has been made more difficult by the variation in eligibility rules across and within states. Cross-state variability requires knowledge of 51 different sets of eligibility rules, whereas within-state variability requires multiple layers of algorithms. This additional complexity makes evaluating SCHIP's success in reaching its target population more difficult. The estimation task is particularly challenging if estimates are desired for separate programs within states.

No single survey captures the full range of information needed for a relatively complete simulation of Medicaid and SCHIP eligibility. For example, the widely used Current Population Survey (CPS) collects no data on assets or expenditures, and nearly all the income data refer to the previous calendar year, rather than the monthly reference period often used to determine Medicaid and SCHIP eligibility. Furthermore, the CPS cannot be used to simulate the waiting periods that states have implemented in SCHIP as an anti-crowd-out feature. The more comprehensive Survey of Income and Program Participation (SIPP) provides detailed income data on a monthly basis and can simulate waiting periods. Its principal limitation is the long interval between data collection and the release of data products--a problem SIPP shares with the Medical Expenditure Panel Survey (MEPS). The MEPS collects nearly as much relevant information as the SIPP, with some of it stronger than the corresponding SIPP data; public use files, however, do not identify individual states, thus making it impossible for users to simulate differences in state thus eligibility rules. The National Health Interview Survey (NHIS), from which the MEPS sample is drawn, also does not identify individual states, and it lacks certain key variables (such as family income by source and assets). The National Survey of America's Families (NSAF) has some of the same limitations as the CPS with respect to the reference period for which income is reported; it too collects fairly limited data on expenditures and resources. The chief strength of NSAF is the comparative data it provides for 13 states that were assigned large samples. We conclude that, of the five surveys we examined, SIPP appears to collect the largest share of the information needed to simulate Medicaid and SCHIP eligibility in the 10 states.3

Clearly, to be credible, the eligibility simulations will have to be detailed. At the same time, they must incorporate major simplifications in order to be feasible. An important task (which is the subject of another report) is determining how simulations of Medicaid and SCHIP eligibility can be adapted to the data limitations without seriously weakening their value as a policy tool (Schirm and Czajka 2000).

The next chapter summarizes our findings on eligibility rules in the 10 states, and Chapter III discusses the implications for comparing eligibility across programs. Chapter IV assesses the data needs for a simulation of eligibility rules, while Chapter V compares the data collected by five national household surveys. We conclude with a discussion of our findings (Chapter VI).

II. Summary of Eligibility Rules

This chapter summarizes state Medicaid and SCHIP eligibility rules in five areas: the types of income tests used, how income is defined, whether an assets test is employed (and, if so, what assets are counted), how family composition is defined, and what other rules (if any) are used.

A. Income Tests

1. Gross and Net Income Tests

When determining income eligibility for Medicaid and SCHIP, states have the option of using a net income test, a gross income text, or both.4 Table II.1 shows the use of these tests by state and by program. In our sample of 10 states, all states use a net income test for their TANF programs; all but Massachusetts use a net income test for their Medicaid 1931 and expansion programs (including both poverty and M-SCHIP expansions).5 S-SCHIP programs, however, often use gross income tests.6 In our sample, the S-SCHIP programs in Alabama, California, Florida, Massachusetts, New Jersey, and New York use gross income tests.7

TABLE II.1
STATE USE OF NET OR GROSS INCOME TESTS

  Medicaid SCHIP Other
TANF 1931/AFDC Poverty Expansion Medicaid Expansion
(M-SCHIP)
State-Designed
(S-SCHIP)
Alabama Net Both Net Net Gross NA
Arkansas Net Net Net Net NA Gross
California Net Net Net Net Gross NA
Colorado Both Both Gross NA Net NA
Connecticut Both Both Net Net Net NA
Florida Both Both Net Net Botha NA
Massachusetts Both Gross Gross Gross Gross NA
Michigan Net Net Net Net Net NA
New Jersey Both Both Net Net Gross NA
New York Both Both Net Net Gross NA
SOURCE: MPR State Income Eligibility Requirements Database.

NOTE: NA = Not applicable

aThe MediKids program for preschool children uses a net income test. The Healthy Kids program for school-age children and their siblings uses a gross income test.

2. Income Thresholds

The threshold tests used by states vary by program. TANF and 1931 Medicaid programs often use the old AFDC standards of payment and need standards for their threshold tests.8 Other standards are used as well. For example, the TANF and 1931 Medicaid programs in Florida use the federal poverty level (FPL) for the gross income test, but the payment standard is used for the net income test.

States may also use a fixed dollar amount for the income test. For example, the 1931 Medicaid program in Alabama uses a fixed dollar amount for its gross income test, and the TANF program in Arkansas uses a fixed dollar amount for its net income test. Although the TANF and 1931 Medicaid programs use a variety of thresholds, the Medicaid poverty expansions and the SCHIP programs in the 10 states use a percentage of the FPL when determining income eligibility for these programs.

B. Defining Income

1. Earnings Disregards

Earnings disregards are employed by most states and most programs that use a net income test. The exceptions in our sample are Colorado's Medicaid poverty expansion and S-SCHIP programs. Earnings disregards are frequently time sensitive--that is, the disregard becomes less generous over time--and the disregard can differ between applicants and recipients.9 Tables II.2 and II.3 show earnings disregards for applicants and recipients, respectively. Today, states have the option to continue using the old AFDC standard earnings disregard policies, or establish new disregards for their TANF and Medicaid programs which are at least as generous as the standards in place on July 16, 1996.10 Among all states, 42 have chosen to establish new earnings disregards for their TANF programs (ACF 1998). In our sample of 10 states, the 1931 Medicaid programs in Arkansas, Florida, and New York have adopted the new earnings disregards used by the state's TANF programs. Other 1931 Medicaid programs continue to use the old AFDC standard, such as the $90 disregard applied to each person with earnings.11 As a result, the disregard used by the state's TANF program may differ from the one used by the 1931 Medicaid program--examples include Alabama, Connecticut, and New Jersey. The Medicaid expansion programs (poverty and M-SCHIP) in our sample states continue to use the old AFDC standard earnings disregard when the program uses a net income test.

TABLE II.2
DESCRIPTION OF EARNINGS DISREGARDS FOR APPLICANTS

  Medicaid SCHIP Other
TANF 1931/AFDC Poverty Expansion M-SCHIP S-SCHIP
Alabama Othera AFDC Standard AFDC Standard AFDC Standard NA NA
Arkansas Otherb Otherb AFDC Standard AFDC Standard NA NA
California AFDC Standard AFDC Standard AFDC Standard AFDC Standard NA NA
Colorado AFDC Standard AFDC Standard NA NA NA NA
Connecticut AFDC Standard AFDC Standard AFDC Standard AFDC Standard AFDC Standard NA
Florida AFDC Standard AFDC Standard AFDC Standard AFDC Standard MediKids:
AFDC Standard
Healthy Kids: NA
NA
Massachusetts Otherc NA NA NA NA NA
Michigan AFDC Standard AFDC Standard AFDC Standard AFDC Standard AFDC Standard NA
New Jersey AFDC Standard AFDC Standard AFDC Standard AFDC Standard NA NA
New York AFDC Standard AFDC Standard AFDC Standard AFDC Standard NA NA
SOURCE: MPR State Income Eligibility Requirements Database.

NOTE:
NA = Not applicable
AFDC Standard: Disregard $90 of earned income.

aDisregard 100 percent of earnings for three months.
bDisregard 20 percent of earnings.
cDisregard $90 of earned income, if exempt. Disregard $120 of earned income for each person with earned income and 50 percent of the remainder, if not exempt.

TABLE II.3
DESCRIPTION OF EARNINGS DISREGARDS FOR RECIPIENTS

  Medicaid SCHIP Other
TANF 1931/AFDC Poverty Expansion M-SCHIP S-SCHIP
Alabama Othera AFDC Standard AFDC Standard AFDC Standard NA NA
Arkansas Otherb Otherb Otherc Otherc NA NA
California Otherd Othere Otherc Otherc NA NA
Colorado AFDC Standard Otherc NA NA NA NA
Connecticut Otherf AFDC Standard AFDC Standard AFDC Standard Otherg NA
Florida Otherh Otherh Otherc Otherc MediKids: Otherc Healthy Kids: NA NA
Massachusetts AFDC Standard NA NA NA NA NA
Michigan Otheri AFDC Standard AFDC Standard AFDC Standard AFDC Standard NA
New Jersey Otherj Otherc Otherc Otherc NA NA
New York Otherk Otherk AFDC Standard AFDC Standard NA NA
SOURCE: MPR State Income Eligibility Requirements Database.

NOTE: NA = Not applicable

AFDC Standards: Disregard $90 + $30 + 1/3 of the remainder of earned income for each person for the first four months. Disregard $90 + $30 of earned income for months 5 through 12. Disregard $90 of earned income for each person with earned income for month 13 and beyond.
aDisregard 100 percent of earnings for three months and disregard 20 percent of earnings for month 4 and beyond.
bDisregard 20 percent of earnings and 60 percent of the remainder.
cDisregard $90 of earned income for each person with earned income.
dDisregard first $225 of the family's disability-based income and earnings and disregard 50 percent of remaining earnings (not including disability-based income).
eDisregard first $240 from the earnings of the two highest earners and disregard first $120 from the earnings of all others. If it is a Sneede case, disregard first $240 from the earnings of each working family member, and disregard 50 percent of the remaining earnings.
fDisregard all earnings below the poverty level.
gDisregard up to 65 percent of the federal poverty level as long as income after disregard is above 235 percent of the federal poverty level.
hDisregard first $200 of earned income and 50 percent of the remainder.
iDisregard $200 and 20 percent of the remainder.
jDisregard 100 percent of the earnings for the first month and 50 percent thereafter.
kDisregard first $90 of earned income for each person with earned income and 45 percent of the remainder.

2. Disregards for Child Care

Many programs continue to use the old AFDC standard disregard for child care expenses.12 All the programs in Alabama, Florida, and New York that use a net income test employ this disregard. Some TANF programs, however, have dropped this disregard when the state implements other forms of child care support for TANF families--for example, programs in Arkansas and California. The treatment of child care expenses, like other policies, may differ across programs within a state, so that the TANF and S-SCHIP programs may not use this type of disregard, but the Medicaid 1931, poverty expansion, and M-SCHIP programs may do so--a pattern found in Arkansas, California, Colorado, and Connecticut.

3. Disregards for Child Support Payments

Medicaid and SCHIP programs are not required to provide a disregard for child support payments made or received. When a program uses this disregard, it typically uses the old AFDC standard of the first $50 received. California continues to use the old AFDC standard but also disregards all court-ordered child or spousal support payments made by the family. Connecticut enhanced the old AFDC standard by raising it to $100 of payments received.

4. Other Disregards

With some exceptions, few states had other significant disregards.13 Connecticut's TANF program raised the irregular gift disregard to $200 per year, but the Medicaid programs use only a $30 yearly disregard for irregular gifts. The Medicaid program in New Jersey disregards all alimony payments. In California, the 1931 Medicaid program and the Medicaid expansion programs (poverty and M-SCHIP) disregard all dependent care expenses from earned income. In Colorado, the S-SCHIP program disregards all medical bills due and payable in the next 12 months.

5. Definition of Countable Income

States have some discretion over the types of income they may or may not count when determining eligibility for Medicaid and SCHIP. Earnings of persons included in the family unit are typically counted, but some states and programs do not count the earnings of children and students-- for example, Arkansas and Connecticut. Arkansas and California also do not count earnings from job training programs. Many states and programs continue the old AFDC standard of not counting SSI benefits, foster care payments, adoption assistance payments, housing subsidies, and earned income tax credits (EITC). In California, however, the S-SCHIP program counts a housing subsidy as income when the subsidy is included in an employment benefit plan. The Connecticut Medicaid program counts housing subsidies--eight percent of the need standard or the actual subsidy, whichever is less.14 The TANF program in Connecticut counts EITC as earned income when it is received as an advance payment. Other types of income that were mentioned as not counted are: supplemental food assistance payments, WIC and food stamp benefits, sibling income, welfare benefit payments, certain types of veteran benefits, and rent received from a roomer or boarder. It is important to note that a state may use gross income tests for its Medicaid and SCHIP programs, but then not count several types of income such as welfare and disability benefits. Massachusetts is an example of such a state.

C. Assets Tests

TANF and 1931 Medicaid programs continue to use assets tests; frequently, these tests are the same for both programs. In our sample of 10 states, these tests have more generous limits for vehicles and other assets than was previously allowed under AFDC.15, 16 While all states in our sample use an assets test for their TANF program, and nine use one in their 1931 Medicaid program, states typically do not use this type of test for their Medicaid poverty or SCHIP programs--for example, Alabama, California, Connecticut, Florida, New Jersey, and New York. The Medicaid poverty expansion programs in Arkansas and Colorado continue to use the old AFDC standard asset test.17 Colorado is the only state in our sample that uses an asset test for its S-SCHIP program.

D. Family Composition Rules

The most challenging and complex rules are those pertaining to family composition. These rules are important because they affect whose income is counted in the unit and the poverty threshold against which family income is measured. Medicaid and SCHIP programs are allowed to establish their own rules for determining family size. Typically family size is determined by the dependent child and his or her natural or adoptive parents and any blood-related or adoptive siblings living in the same household. But programs employ numerous exceptions or special provisions regarding minor parents, pregnant women, multigeneration households, stepparents and stepsiblings, SSI recipients, and certain aliens. As a result, family size may differ across different programs.

The most striking finding is that TANF and Medicaid programs (including M-SCHIP) continue to use complex rules that are based on old AFDC standards, while S-SCHIP programs may use simpler rules. S-SCHIP programs in Colorado, Florida, New Jersey, and New York count everyone who lives with the applicant child; that is, they do not include or exclude household members based on their relationship to the applicant child. This is an important finding because it implies that, in several states, S-SCHIP programs count Supplemental Security Income (SSI) beneficiaries and SSI benefit payments, which Medicaid programs do not.18 Also, S-SCHIP programs may count other types of individuals such as stepparents and grandparents (as well as their income) when they are not counted by Medicaid programs or only at the discretion of the applicant or under certain circumstances. Finally, it is fairly common for programs (Medicaid and SCHIP) to count unborn children in determining the family size on which most income or poverty thresholds are based.

E. Other Rules

1. Presumptive Eligibility

Presumptive eligibility rules in the Medicaid program allow certain, qualified health care providers to grant pregnant women immediate, typically 60 days, of Medicaid coverage at the provider site. Formal eligibility would be made during the presumptive period. SCHIP programs have the option of providing presumptive eligibility. In most states, the only programs using presumptive eligibility rules are the Medicaid poverty expansion programs. Examples are California, Colorado, Connecticut, Florida, and New Jersey. In California, the TANF program also offers presumptive eligibility for families in emergency situations, and in Massachusetts, all but the TANF program offer presumptive eligibility to all applicants. Few S-SCHIP programs have taken up this option, but the program in New York offers one 60-day period of presumptive eligibility for each child.

2. Private Health Insurance

SCHIP programs are required to implement anti-crowd-out policies that prevent or discourage families and businesses from dropping a child's current coverage for coverage through the SCHIP program. Programs are implementing an array of policies, such as imposing waiting periods without health insurance--Alabama, California, Colorado, Connecticut, Florida, and New Jersey. Colorado, for example, imposes a three-month waiting period if the family has refused health coverage where the employer pays at least 50 percent of the cost of coverage. Another policy option is to deny coverage when employer-sponsored coverage is available. Only Michigan has implemented this option in its S-SCHIP program.

The next chapter explores the implications of these cross-state and within-site variations for simulating eligibility for coverage under Medicaid or SCHIP.

III. Implications for Comparing Eligibility Among States and Programs

As we show in Chapter II, the variability of income eligibility rules for Medicaid and SCHIP programs is staggering. While we expected to find marked differences in rules across states, the degree of within-state differences was somewhat surprising. This level of variability has two important implications for efforts to simulate Medicaid and SCHIP eligibility and derive estimates of the number of children who are eligible but remain uninsured. First, policymakers, advocates, and researchers cannot simply compare the income thresholds states use in their programs and fully understand how the various Medicaid or SCHIP programs have expanded eligibility for low-income children. For example, when a state uses a Medicaid income threshold of 133 percent of FPL and an S-SCHIP threshold of 200 percent of FPL, the coverage expansion is not a simple difference of 67 percentage points when the Medicaid program uses net income and narrow definitions of "family" and the S-SCHIP program uses gross income and inclusive definitions of family. In reality, the effective difference is much less, as we will demonstrate in this chapter.

Second, the level of variability makes it a challenging task to simulate eligibility for Medicaid and SCHIP, particularly when a high level of precision is desired. Not only must Medicaid and SCHIP rules be programmed separately, but multiple sets of rules may be necessary for each state, in order to identify situations where a child is found eligible under programs thought to have more restrictive income requirements, but who is ineligible for programs with less restrictive income criteria (but, also, less generous disregards). For example, it may be possible that, under certain circumstances, a child may qualify for Medicaid through the TANF program and its generous earnings disregards, but not under poverty expansion rules.

To develop a better understanding of the implications of the variation in eligibility rules, we determined maximum allowable earnings for Medicaid and SCHIP programs in our sample of 10 states. More specifically, we took into account the rules regarding the counting of income and disregards for earnings and child care to determine the maximum amount a family of three can earn and remain eligible for the program. Child care disregards were included in this calculation because, after earnings, they are the most common type of disregard.

The top panel in Table III.1 presents the income threshold for a family of three used by each program in each state. Maximum allowable earnings for a family of three are presented in the bottom panel. The dollar amounts in Table III.1 are translated into the percentage of the 1999 FPL in Table III.2. Maximum allowable earnings for TANF programs range from 23 percent of FPL in Arkansas to 95 percent of FPL in Massachusetts. The Medicaid 1931 levels range from 22 percent of FPL in Alabama to 133 percent in Massachusetts.

In most states, the Medicaid 1931 program either covers the same range of income as the TANF program, or extends coverage to children at slightly higher earnings levels. The one exception is Arkansas, where the TANF program has an effective income level slightly higher than that of the Medicaid 1931 program. Although both programs use a net income test, the threshold used by the TANF program is greater than that of the Medicaid 1931 program.19

For the Medicaid poverty expansion programs, we calculated the maximum allowable earnings for three different age groups--preschool-age children, children ages 6 through 15, and children 16 and older if the Medicaid program extended coverage to older adolescents. In 9 of the 10 states, the Medicaid poverty expansion programs expand coverage for children in families with incomes substantially above the limits for the TANF and 1931 programs (Massachusetts is the exception). All the states in our sample establish eligibility at maximum allowable earnings that exceed the mandated threshold of 100 percent of FPL for children age 6 and older, and all meet or exceed the mandate of 133 percent of FPL for children age 1 through 5. Connecticut is the most generous; maximum allowable earnings for eligibility are slightly above 200 percent of FPL for all children born after September 30, 1983.

  Alabama Arkansas California Colorado Connecticut Florida Massachusetts Michigan New Jersey New York

TABLE III.1
INCOME THRESHOLDS AND MAXIMUM ALLOWABLE EARNINGS AS OF JANUARY 1, 1999 FOR A FAMILY OF THREE

Thresholds for Income Tests for a Family of Three
TANF $164 $223 $775 $421 $872 $303 $539 $459 $636 $577
1931 $164 $204 $775 $421 $872 $303 $1,539 $459 $443 $577
Poverty
Children ages 1 through 5 $1,539 $1,539 $1,539 $1,539 $2,140 $1,539 $1,539 $1,736 $1,539 $1,539
Children ages 6 through 15 $1,157 $1,157 $1,157 $1,157 $2,140 $1,157 $1,539 $1,736 $1,157 $1,157
Children age 16 and older Not eligible $1,157 Not eligible Not eligible Not eligible Not eligible $1,539 Not eligible Not eligible Not eligible
M-SCHIP $1,157 $1,157 $1,157 NP $2,140 $1,157 $1,736 $1,736 $1,539 $1,157
S-SCHIP $2,314 $2,314a $2,314 $2,140 $3,471 $2,314 $2,314 $2,314 $2,314 $2,140
Maximum Allowable Earnings for a Family of Threeb
TANF $372 $268 $865 $511 $962 $568 $1,104 $724 $636 $842
1931 $429 $251 $1,040 $686 $962 $568 $1,538 $724 $708 $842
Poverty
Children ages 1 through 5 $1,803 $1,803 $1,803 $1,713 $2,405 $1,803 $1,538 $2,000 $1,803 $1,803
Children ages 6 through 15 $1,422 $1,422 $1,422 $1,332 $2,405 $1,422 $1,538 $2,000 $1,422 $1,422
Children age 16 and older Not eligible $1,422 Not eligible Not eligible Not eligible Not eligible $1,538 Not eligible Not eligible Not eligible
M-SCHIP $1,422 $1,422 $1,422 NP $2,405 $1,422 $1,735 $2,000 $1,803 $1,422
S-SCHIP $2,313 $2,313a $2,313 $2,313c $3,735 Healthy Kids: $2,313 MediKids: $2,578 $2,313 $2,578 $2,313 $2,230
SOURCE: MPR State Income Eligibility Requirements Database.

NOTE: NP = No program

aThis income level is for the ARKids First program. The program is currently a 1115 Medicaid Waiver program, but the state plans to convert it into an S-SCHIP program.
bCalculated as the income threshold plus any earnings and child care disregards. All income is assumed to be from earnings. Child care disregards are included because they are the most common form of disregard after earnings disregards. In addition, child care disregards are taken from earned and unearned income, unlike child support disregards which are taken from child support payments received by the family.
cThis is the lower bound and assumes no child care expenses. The S-SCHIP program in Colorado disregards all child care expenses.

  Alabama Arkansas California Colorado Connecticut Florida Massachusetts Michigan New Jersey New York

TABLE III.2
INCOME THRESHOLDS AND MAXIMUM ALLOWABLE EARNINGS AS OF JANUARY 1, 1999 FOR A FAMILY OF THREE AS A PERCENT OF THE 1999 FEDERAL POVERTY LEVEL (FPL)

Thresholds for Income Tests for a Family of Three as a Percent of the 1999 FPL
TANF 14 19 67 36 75 26 47 40 55 50
1931 14 18 67 36 75 26 133 40 38 50
Poverty
Children ages 1 through 5 133 133 133 133 185 133 133 150 133 133
Children ages 6 through 15 100 100 100 100 185 100 133 150 100 100
Children age 16 and older Not eligible 100 Not eligible Not eligible Not eligible Not eligible 133 Not eligible Not eligible Not eligible
M-SCHIP 100 100 100 NP 185 100 150 150 133 100
S-SCHIP 200 200a 200 185 300 200 200 200 200 185
Maximum Allowable Earnings for a Family of Threebas a Percent of the 1999 FPL
TANF 32 23 75 44 83 49 95 63 55 73
1931 37 22 90 59 83 49 133 63 61 73
Poverty
Children ages 1 through 5 156 156 156 148 208 156 133 173 156 156
Children ages 6 through 15 123 123 123 115 208 123 133 173 123 123
Children age 16 and older Not eligible 123 Not eligible Not eligible Not eligible Not eligible 133 Not eligible Not eligible Not eligible
M-SCHIP 123 123 123 NP 208 123 150 173 156 123
S-SCHIP 200 200a 200 200c 323 Healthy Kids: 200 MediKids: 223 200 223 200 193
SOURCE: MPR State Income Eligibility Requirements Database.

NOTE: NP = No program

aThis income level is for the ARKids First program. The program is currently a 1115 Medicaid Waiver program, but the state plans to convert it into an S-SCHIP program.
bCalculated as the income threshold plus any earnings and child care disregards. All income is assumed to be from earnings. Child care disregards are included because they are the most common form of disregard after earnings disregards. In addition, child care disregards are taken from earned and unearned income, unlike child support disregards which are taken from child support payments received by the family.
cThis is the lower bound and assumes no child care expenses. The S-SCHIP program in Colorado disregards all child care expenses.

Comparing maximum allowable earnings under the poverty expansion programs against the thresholds states use in their income eligibility tests is particularly illuminating. Most states in our sample establish the income threshold for determining eligibility among preschool-age children at the mandatory 133 percent of FPL. Michigan and Connecticut are more generous, at 150 and 185 percent of FPL, respectively. The maximum allowable earnings for all states exceed this level by 15 to 23 percentage points, with the exception of Massachusetts which matches the mandatory level.

The same pattern is seen for children six and older. Most states use the mandatory threshold of 100 percent of FPL--the exceptions are Connecticut (185 percent of FPL), Massachusetts (133 percent of FPL), and Michigan (150 percent FPL). The maximum allowable earnings exceed the income threshold for determining eligibility in all states except Massachusetts; nevertheless, at 133 percent of FPL, the Massachusetts level for maximum allowable earnings for children six and older is more generous than that in seven other states in our sample.

The impact of M-SCHIP programs in the 10 states is primarily to extend coverage among teens and older adolescents. Until the introduction of M-SCHIP in states such as Alabama, California, Connecticut, Florida, Michigan, New Jersey, and New York, children born before September 30, 1983 were eligible for Medicaid coverage only through TANF and the Medicaid 1931 programs. 20 In these states, M-SCHIP represents a significant extension of coverage for teenagers from maximum allowable earnings for the TANF and Medicaid 1931 programs, which are frequently below poverty, to levels slightly above poverty for the M-SCHIP programs.

Because Medicaid poverty expansion and M-SCHIP programs substantially extend the level of earnings families can have and remain eligible for the Medicaid program, the value of simulating the generally more complex TANF and 1931 Medicaid rules may appear to be limited, but it is not. Establishing eligibility for older teenagers still requires simulating eligibility for these programs. Further, there are several reasons why it is important to simulate full family eligibility--for example, to investigate whether participation rates are higher when the parents are eligible along with the children or when all children in a family are eligible to participate. In these cases, the simulation of TANF and Section 1931 Medicaid program eligibility becomes relevant for all children.

S-SCHIP programs in our sample expand eligibility for children but not to the extent suggested by the income thresholds used to determine eligibility. When comparing income thresholds between the Medicaid poverty expansion programs and the S-SCHIP programs, states such as Alabama, Arkansas, California, Florida, and New Jersey appear to extend eligibility from 133 to 200 percent of FPL for preschool-age children, an expansion of 67 percentage points. When maximum allowable earnings are the basis of comparison, S-SCHIP expands coverage from 156 to 200 percent of FPL, an expansion of 44 percentage points--still a considerable expansion, but less than that suggested by the difference in the income thresholds used in income eligibility tests.

To demonstrate more fully how the variations in the design of income tests and disregards impact the program eligibility of children we chose a hypothetical three-person household, a mother and her two children ages three and nine, and simulated the children's eligibility at two different levels of gross income and under two different assumptions about the family's qualifications for child care and child support disregards.21, 22 Table III.3 presents the results of our simulations. More detailed information about the results of the simulations is presented in Appendix Tables 1 through 4.

The first two simulations (shown in the top panel of Table III.3) assume the mother works full-time at minimum wage ($5.15 per hour) and receives $100 per month in child support payments, for an annual gross income of $11,912, which is 86 percent of the 1999 FPL. These simulations demonstrate that when gross family income is slightly below poverty, young children typically are eligible for Medicaid coverage through the poverty expansion provisions. Only in California, Connecticut, and Massachusetts are the children eligible for Medicaid through 1931 provisions. The difference in the two simulations reflects the impact of child care and child support disregards on eligibility. At this level of gross income these disregards have little impact on overall eligibility for Medicaid. Only in California and Connecticut does the children's eligibility group change--from the 1931 program to the poverty expansion group--when disregards are limited to earnings.

The second set of simulations (shown in the bottom panel of Table III.3) demonstrates eligibility when gross family income is slightly above the poverty level. These simulations assume the mother works full-time at $7 per hour and she receives $100 a month in child support payments, for an annual gross income of $15,760, which is 114 percent of the 1999 FPL. Both children are eligible for Medicaid coverage through the poverty expansion provisions when the family qualifies for all earnings, child care, and child support disregards, except in Massachusetts where the children are eligible through the 1931 program. At this income level, however, the child care and child support disregards in seven states determine whether both children are covered by the Medicaid poverty expansion program or the mother must negotiate two insurance programs, Medicaid for the preschooler and SCHIP for the school age child.23 Negotiating two insurance programs may not be difficult if the two programs are well integrated in terms of eligibility and redetermination processes, covered benefits, and provider networks. But if they are not, the mother may face considerable challenges to understanding and using the Medicaid and SCHIP health care systems.

Disregards Alabama Arkansas California Colorado Connecticut Florida Massachusetts Michigan New Jersey New York

TABLE III.3
IMEDICAID AND SCHIP ELIGIBILITY AS OF JANUARY 1, 1999 OF TWO CHILDREN AGES THREE AND NINE IN A THREE-PERSON FAMILYa BY STATE, BY INCOME, AND BY DISREGARDS

Gross Income Slightly Below Poverty (86 percent of FPL)b
All Disregardsc Poverty Poverty 1931 Poverty TANF/1931 Poverty 1931 Poverty Poverty Poverty
Earnings only Poverty Poverty Poverty Poverty Poverty Poverty 1931 Poverty Poverty Poverty
Gross Income Slightly Above Poverty (114 percent of FPL)d
All Disregardsc Poverty Poverty Poverty Poverty Poverty Poverty 1931 Poverty Poverty Poverty
Earnings only Poverty
3 year old S-SCHIP 9 year old
Poverty
3 year old ARKids 9 year old
Poverty
3 year old S-SCHIP 9 year old
Poverty
3 year old S-SCHIP 9 year old
Poverty Poverty
3 year old S-SCHIP 9 year old
1931 Poverty Poverty
3 year old  M-SCHIP 9 year old
Poverty
3 year old S-SCHIP 9 year old
SOURCE: MPR State Income Eligibility Requirements Database.

NOTE:
SCHIP=State Children's Health Insurance Program.
M-SCHIP=Medicaid expansion
S-SCHIP=State-designed program
FPL=1999 Federal Poverty Level
TANF=Transitional Assistance for Needy Families

aFamily composition assumes a mother and her two children ages three and nine.
bThe mother works 40 hours/week at minimum wage ($5.15/hour). The family receives $100/month in child support payments. Annual gross income is $11,912.
cFamily qualifies for all earnings, child care, and child support disregards used by the state's TANF, 1931, Poverty, M-SCHIP, and S-SCHIP programs.
dThe mother work 40 hours/week at $7/hour. The family receives $100/month in child support payments. Annual gross income is $15,760.

We conducted a second set of simulations to look at how eligibility changes for a range of income levels. In these simulations we assumed a three-person family with two earners and one child. The child's program eligibility is determined at four levels of gross income, 100, 150, 200, and 250 percent of FPL. Table III.4 presents the results of these simulations. Detailed simulation results are presented in Appendix Tables 5 through 12.

The top panel of Table III.4 shows the program eligibility if the child is five years old and the family qualifies for all child care disregards in addition to disregards for earnings. The bottom panel shows the program eligibility if the child is 17 years old. These simulations demonstrate that as income increases, SCHIP becomes a critically important program. The five year old is primarily covered by the poverty expansion provisions when income is at or below 150 percent of FPL. Note, however, that when income as at 150 percent of FPL this child would not have been eligible for federally financed public insurance in Colorado and Massachusetts if SCHIP was not available. When income reaches 200 percent of FPL, the child would be covered by SCHIP in all states but Connecticut. At 250 percent of FPL the child is only eligible for coverage in Connecticut. For the adolescent, SCHIP coverage is extremely important, even when income is as low as 100 percent of FPL. At that level the child would not have been eligible for federally financed public insurance coverage if SCHIP was not available in 6 of the 10 states. At 150 and 200 percent of FPL, the child is eligible for SCHIP coverage in all states. Only Connecticut covers the child when income reaches 250 percent of FPL.

Income as a percent of FPL Alabama Arkansas California Colorado Connecticut    Florida    Massachusetts  Michigan  New Jersey New York

TABLE III.4
MEDICAID AND SCHIP ELIGIBILITY AS OF JANUARY 1, 1999 OF A CHILD IN A THREE-PERSON FAMILY WITH TWO EARNERSa BY STATE AND BY INCOME

5 year old child
100   Poverty   Poverty Poverty Poverty Poverty Poverty 1931 Poverty Poverty Poverty
150 Poverty Poverty Poverty S-SCHIP Poverty Poverty M-SCHIP Poverty Poverty Poverty
200 S-SCHIP ARKids S-SCHIP S-SCHIP Poverty S-SCHIP S-SCHIP S-SCHIP S-SCHIP S-SCHIPb
250 Not eligible Not eligible Not eligible Not eligible S-SCHIP Not eligible Not eligible Not eligible Not eligible Not eligible
17 year old childd
100 M-SCHIP Poverty M-SCHIP S-SCHIP Poverty M-SCHIP 1931 Poverty M-SCHIP M-SCHIP
150 S-SCHIP ARKids S-SCHIP S-SCHIP M-SCHIP S-SCHIP M-SCHIP M-SCHIP S-SCHIP S-SCHIP
200 S-SCHIP ARKids S-SCHIP S-SCHIP M-SCHIP S-SCHIP S-SCHIP S-SCHIP S-SCHIP S-SCHIPb
250 Not eligible Not eligible Not eligible Not eligible S-SCHIP Not eligible Not eligible Not eligible Not eligible Not eligible
SOURCE: MPR State Income Eligibility Requirements Database.

NOTE:
SCHIP=State Children's Health Insurance Program.
M-SCHIP=Medicaid expansion
S-SCHIP=State-designed program
FPL=1999 Federal Poverty Level

aThe simulations for the 5 year old include child care disregards where applicable.
bIn another simulation that assumed only one earner, the child is not eligible for coverage at this level of income.

The simulations presented in this chapter involved hypothetical families and simplified assumptions about their income and expenses. In the next chapter we discuss what the complexity of the Medicaid and SCHIP eligibility rules implies about the simulation of eligibility with national household data.

IV. Implications for Simulations Based on Household Survey Data

Simulating eligibility for Medicaid and SCHIP involves applying state rules for determining program eligibility to the data collected in a household survey. The data would be sufficient for a step-by-step replication of the eligibility determination process, but this remains only an ideal. With data from SIPP, researchers have achieved a high level of precision in simulating eligibility under the Food Stamp Program (FSP), but the rules for FSP are relatively simple compared with those for other means-tested programs, and they do not vary from state to state.

Medicaid eligibility has proven much more difficult to simulate, for several reasons. The detailed rules are not well documented. They vary from state to state. They require extensive household- and person-level data to replicate. And the kinds of data they require cut across the subject matter specialization of our major national surveys.

It would appear that SCHIP has taken state-to-state variation a step further than Medicaid. Thus, differences between states and even within states (between programs) in how income and resources are counted may prove equally daunting to efforts to simulate SCHIP eligibility. In addition, anti-crowd-out features have imposed new demands on simulation efforts.

In this chapter we outline the features of a generic SCHIP simulation routine. Then we compare the data requirements to the information collected in five national household surveys.

A. Data Requirements for Eligibility Simulations

While simulation models take different forms, a model that seeks to capture all aspects of the eligibility determination process must include each of the following steps, which are applied, in turn, to every household in the database:

  • Determine state of residence. This will determine the specific set of eligibility rules to be applied.
  • Identify the members of each family unit. Using the reported relationships between household members, their ages, and their receipt of particular benefits, the members of one or more families are identified for the purpose of determining their joint eligibility or, for child-specific eligibility, who should be counted in determining family income and the applicable poverty thresholds. Note, for example, that a family member who receives SSI generally will be eligible for Medicaid (and ineligible for SCHIP), and that both the family member and the amount of the SSI payment will often (but not always, particularly among S-SCHIP programs) be excluded in determining the Medicaid or SCHIP eligibility of other family members.
  • Determine categorical eligibility. Determine if the child or family meets any categorical eligibility criteria that may confer automatic or at least conditional eligibility.
  • Calculate gross income. Sum all sources of income that are counted under program rules for all members of the family. A state may define what is counted in gross income differently across programs, requiring multiple totals.
  • Identify the components of income to which disregards may apply. Calculate total earnings and calculate or impute the totals for other sources of income that are partially or totally disregarded by one or more programs within the state.
  • Identify the expenditures to which disregards may apply. Using the amounts reported for child care and other expenditures for which applicants are allowed to disregard part of their income, calculate or impute the amount of each expenditure.
  • Calculate net income. Apply the disregard rules to the corresponding income or expenditure amounts and calculate net income as gross income minus the disregards. A state may define net income differently across programs, requiring multiple totals.
  • Calculate the family poverty level. Divide gross or net income, as appropriate, by the applicable poverty threshold (which depends on family size) to obtain the family poverty level for the family unit or units identified above. If a state defines income differently across programs that use poverty levels as income thresholds, it will be necessary to calculate multiple poverty levels.
  • Determine eligibility based on income. Compare the poverty level or net or gross income, as appropriate, to the applicable threshold for each state program to determine income eligibility.
  • Calculate countable assets and apply asset test. Using reported or imputed assets, determine whether countable assets exceed the asset limit. Within a state, different programs may or may not require an asset test, or they may define the test differently, thus, possibly requiring multiple tests.
  • Determine insurance coverage. A child who is insured under an employer-sponsored plan or whose family has declined such coverage recently may be ineligible for a S-SCHIP program despite being eligible by all other criteria. Similarly, an uninsured child who did not lose coverage until relatively recently may be ineligible until the spell reaches a specified length (for example, six months). To simulate this program feature requires information on both "current" coverage (that is, contemporaneous with the measure of eligibility) and, for the uninsured, a measure of the duration of the current spell.
  • Determine eligibility by program. Using the results of the categorical eligibility, income, and asset tests, along with reported insurance coverage, determine whether the family or child is eligible for any of the programs offered within the state. If the state has a medically needy program and the family is not otherwise eligible, determine if the family's medical expenditures would allow the family to spend down to the applicable income limit.

B. Comparison of Five National Surveys

Four of the federal government's national household surveys may appeal to users as potential data sources for estimates of the number of children who are eligible for Medicaid and SCHIP plans over the next several years:

  • The March supplement to the Current Population Survey (CPS)
  • The 1996 and later panels of the Survey of Income and Program Participation (SIPP)
  • The National Health Interview Survey (NHIS), which underwent a major redesign in 1997
  • The Medical Expenditure Panel Survey (MEPS), which was initiated in 1996, with additional panels scheduled to start in subsequent years

A fifth, privately sponsored survey, the Urban Institute's National Survey of America's Families (NSAF), will also make important contributions to national estimates of Medicaid and SCHIP-eligible children, although the sample design of that survey, with its focus on 13 states, may lead researchers to place greater emphasis on estimates for those 13 states. The first NSAF was conducted in 1997, a second wave was fielded in 1999, and a third wave is planned for 2001.

Another important survey is the Community Tracking Study (CTS), funded by the Robert Wood Johnson Foundation (RWJF) and conducted by the Center for Studying Health System Change. The CTS household survey was fielded in 1996-1997, with a second round in 1999. The household survey sample of more than 60,000 respondents was selected from 60 randomly chosen communities representing about half the U.S. population plus a small, nationally representative supplemental sample designed to improve the precision of the sample for national-level estimates. About half of the 60-site sample were selected from 12 communities, to enable site-level analysis for these localities. Because of the community focus of the sample, the CTS is not an obvious choice for national- or state-level simulation of Medicaid or SCHIP eligibility based on the application of state eligibility rules, we have not included the CTS in our comparison of surveys.

Table IV.1 compares the five surveys with respect to their collection of the data elements needed to simulate children's eligibility for Medicaid and SCHIP in the 10 states we studied. The data elements include state of residence, family income by source, income by family member, the income reference period, resources, program participation, expenditures, family composition, characteristics of children, immigration status, and health insurance coverage.

We note right away that neither the NHIS nor the MEPS public use files identify state of residence, making it impossible for public users to incorporate the state variation in eligibility discussed earlier. Unless provision is made to give researchers access to state identifiers under arrangements that will maintain the security of these data, it will be difficult for NHIS or MEPS to make a major contribution to national (let alone state-level) estimates of SCHIP eligibility. SIPP restricts the identification of a small number of states, due to confidentiality concerns, while the NSAF policy on state identification outside the 13 study states remains unclear. If the state of residence is not released with the NHIS or MEPS files, the major value of those databases for Medicaid and SCHIP simulation may be as sources of ancillary information to support the imputation of variables not collected in CPS or SIPP.

Survey Variable March 1998 CPS SIPP 1996 Panel NHIS 1997 Redesign 1996 MEPS 1997 NSAF

TABLE IV.1
DATA AVAILABILITY RELATIVE TO REQUIREMENTS FOR SIMULATION OF MEDICAID AND SCHIP ELIGIBILITY

State of residence Yes Yesa Nob Nob Yesc
Family income by source
Total family income Yes Yes Yes Yes Yes
Earnings Yes Yes Yes Yes Yes
AFDC/TANF Yes Yes No Yes Yes
Earned income tax credit Yes Yes No No No
SSI Yes Yes No Yes Yes
Other cash assistance Yes Yes No Yes Yes
Child support Yes Yes No Yes Yes
Foster child care No Yes No No Yes
Gifts No Yes No Yes Yes
Asset income Yes Yes No Yes Yes
Other unearned income Yes Yes No Taxable Yes
Income by family member
Earnings Yes Yes Yes Yes Yes
Other sources Yes Yes No Yes Yes
Income reference period
Family income by source Last year Monthly Last year Mixed Last year
Earnings (most recent period) Last week Monthly Last year Monthly Last week
Resources
Financial assets No Yes No Yes No
Noncommercial vehicles No Yes No Yes No
Program participation by person
AFDC/TANF Yes Yes Yes Yes Yes
SSI Yes Yes Yes Yes No
Expenditures
Shelter No Yes No No Yes
Child care No Yes No No Yes
Other dependent care No No No No No
Medical care No Yes Yes Yes No
Health insurance premiums No Yes Yes Yes No
Alimony paid No Yes No No No
Child support paid No Yes No No No
Family composition
Headship type Yes Yes Yes Yes Yes
Family relationships Yes Yes Yes Yes Yes
Total members Yes Yes Yes Yes Yes
Pregnancy No No Yes Yes Yes
Characteristics of children
Age by single year Yes Yes Yes Yes Yes
Date of birth No Yes Yes Yes No
School enrollment Yes Yes Yes Yes Yes
Disability No Yes Yes Yes Yes
Immigration status
U.S. citizenship Yes Yesd Yes Yes Yes
Year of entry Yes Yesd Yes Yes Yes
Legal versus undocumented No No No No No
Health insurance coverage
Current coverage No Yes Yes Yes Yes
Duration of current uninsured spell No Yes Yes Yes No
Availability of employer-sponsored insurance (ESI) No Yese Yes Yes Yes
Months since last covered by ESI No Yes No Yes No
Coverage in past year Yes Yes No Yes Yes
Ever uninsured in past year No Yes Yes Yes Yes
aFive small states are not identified individually but as groups of two and three.
bState will not be identified on the public use files released for this survey.
cGiven the small sample sizes for most states, we are not certain that all states will be identified on future public use files released for this survey, but we have not seen any statement to the contrary.
dReported for persons 15 and older.
ePeople who are uninsured are asked if they were offered employer-sponsored coverage and if they were eligible. These data will not be available for people who reported other coverage.

It is evident that, even if reporting the state of residence were not an issue, no single survey captures the full range of information needed for a relatively complete simulation of Medicaid and SCHIP eligibility and that each of the surveys possesses certain comparative strengths, along with weaknesses. For example, data on expenditures and assets are weak generally. While all the surveys identify aliens, none differentiates legal from undocumented aliens--an important distinction for SCHIP eligibility.

The CPS has been, and will almost surely continue to be, the chief source of estimates of Medicaid and SCHIP eligibles, owing to the timely release of March CPS data and the fact that CPS has become the official source for the measurement of family income and poverty in the United States. CPS has nearly achieved that status with respect to the measurement of health insurance coverage as well. Yet CPS has several notable limitations. It contains no data on assets or expenditures, leaving researchers either to impute the missing amounts or to simulate their impact more crudely, or to exclude them from consideration altogether. For instance, it is common for simulations of Medicaid eligibility based on the CPS to provide no estimates of children or adults who are eligible under the medically needy provisions. As an increasingly large proportion of children become eligible under poverty-related expansions and SCHIP extensions, eligibility under the medically needy provisions becomes less and less important for children, although this program remains important for adults and families.

A less obvious limitation of the CPS, but one that is nevertheless important, is its reference period. Except for earnings, for which CPS collects current information, all the income data collected in the survey refer to the previous calendar year. Since Medicaid and SCHIP eligibility are determined on the basis of monthly income, and many of those who qualify have fluctuating incomes, rather than persistently low ones, researchers using CPS must choose among some less-than-perfect options. One option is to calculate eligibility based on one-twelfth of annual income, recognizing that this will understate the number of children eligible in an average month. Another option is to modify the first strategy by adjusting the results to reflect the relationship between monthly and annual poverty that is observed in other data, such as SIPP. A third approach is to simulate monthly income streams for different sources, relying on the number of weeks respondents report having worked in the previous year, to determine the number of months with few or no earnings and to integrate the streams for different sources, based on assumptions or external evidence (such as from SIPP) about their covariation. Eligibility can then be simulated for a selected month. Both the Urban Institute and MPR employ this last approach in their respective CPS-based microsimulation models. Regardless of the approach taken, the reporting of health insurance coverage in annual rather than monthly terms makes it unclear how best to align reported coverage with simulated eligibility for Medicaid and SCHIP.

SIPP provides monthly data on income, family composition, and insurance coverage; also it allows the simulation of waiting periods and collects asset data and expenditure data annually. Finally, SIPP provides the most extensive coverage of the full range of variables reported in Table IV.1. Where SIPP continues to fall short of the ideal most conspicuously is in the timely release of data. While the Census Bureau is currently completing the fourth and final year of data collection, only the first 16 months of data have been released.

To date, NHIS has not been a popular vehicle for estimating Medicaid eligibility. While changes to make the data available sooner are occurring, NHIS lacks many of the items identified in Table IV.1, and, as we reported earlier, state identifiers are not released with the public use files. The principal value of NHIS for simulating Medicaid and SCHIP eligibility may lie in its capture of health insurance coverage--arguably better than CPS, because it captures coverage at the time of the interview, so that reported coverage is not subject to recall error or misinterpretation of the reference period. In addition, NHIS captures detailed information on health status, activity limitations, and access to care.

Because of the aforementioned lack of state identifiers, the MEPS appears to hold greater promise as a source of data for imputing information not captured in SIPP or CPS than as a direct source of estimates of Medicaid and SCHIP eligibility. The comparative strengths of MEPS include the breadth of its information on health care expenditures and employer coverage. In addition, because MEPS uses a different approach than SIPP to capture changes in coverage over time, MEPS data provide a potentially important source for validating some of the health insurance dynamics observed in SIPP.

Finally, NSAF has some of the same limitations as CPS with respect to the reference period for the reporting of income, and it collects fairly limited data on expenditures and resources. These limitations suggest that users of the NSAF would have to employ more simplifications than would be needed with SIPP to simulate eligibility for Medicaid or SCHIP. Its chief value lies in the comparative information it will provide for the 13 states that are represented with very large samples.

V. Discussion

For every step in the simulation process, our findings indicate that there is at least some variation across the states. Often, there is variation across programs within a state as well. Replicating this variation in simulation algorithms presents an enormous challenge to researchers and one that must invariably involve many simplifications. The data requirements alone are sizable. Other aspects of the simulation of Medicaid and SCHIP eligibility may be difficult to implement, either because a detailed state-by-state and program-by-program description is unavailable, or because the task of coding each nuance demands more resources than most research teams can afford to allocate to the effort.

Determining the family unit continues to be one of the most complex steps, both because of its data requirements and because the rules vary both across and within states; these rules remain among the most difficult to document. Furthermore, the counting or not counting of individual family members (and their income) in calculating the poverty level of a child's family can be the determining factor in whether or not a child is deemed eligible for a particular program. A further complication is introduced by program rules that count unborn children in determining family size. Since information on pregnancy is not collected in two of the major surveys, taking account of this aspect of eligibility in a simulation may require data that simply are not available.

The anti-crowd-out features of the programs developed under S-SCHIP impose important new demands on simulation models--ones that will be difficult to satisfy. Only panel surveys provide the data required to simulate waiting periods, and panel data generally lack the timeliness that is desirable for estimates of eligibles.

The fact that many states seem to be using gross rather than net income to establish eligibility under their S-SCHIP programs implies that simulating eligibility under the full array of programs within a state may be easier than simulating eligibility under Medicaid alone. At the same time, however, the S-SCHIP programs appear to be introducing other complications into the simulation process, if only through their variability across states.

Clearly, to be credible, eligibility simulations will have to be detailed. At the same time, however, our review of the data collected by five major surveys indicates that the simulations will have to incorporate major simplifications to be feasible. No single data source contains all the elements necessary to mimic Medicaid and SCHIP eligibility determination with a high degree of precision. How simulations of Medicaid and SCHIP eligibility can be adapted to the data limitations, while, at the same time ensuring their value as a policy tool, remains a considerable challenge.

Footnotes

1. The rules and policies discussed in this report are current as of January 1, 1999.

2. Within our sample of 10 samples, all but Arkansas, California, and New York automatically enroll TANF recipients into the Medicaid program.

3. The Community Tracking Survey was not included in our assessment of household surveys because the community focus of the sample does not make it an obvious choice for state-level simulation.

4. Applicants to AFDC first had to pass a gross income test which was set at 185 percent of the Federal poverty level. If gross income was below this threshold, then net income was determined and compared against the state's threshold for net income.

5. The Colorado Medicaid poverty expansion program and the S-SCHIP program do not use an earnings disregard. We classify these programs as using a net income test because they use child support and child care disregards, and the S-SCHIP program disregards all medical care bills due and payable within 12 months.

6. Data reported by the National Academy for State Health Policy show that, as of the summer of 1998, 13 M-SCHIP programs and 14 S-SCHIP programs used a gross income test (NASHP 1999).

7. In Florida, the Healthy Kids program for school-age children and their siblings uses a gross income test; the MediKids program, which is a Medicaid look-alike program for preschoolers, uses a net income test.

8. Need and payment standards are set by the states. The need standard reflects the dollar amount a "needy person" requires to obtain basic essentials such as housing and food. The payment standard is the maximum cash benefit paid by the AFDC program. The payment standard is frequently below the need standard. States use a variety of methods to calculate these standards, but all adjust them for family size.

9. The earnings disregard in the Massachusetts TANF program distinguishes between those who are or are not exempt from work requirements. People exempt from work requirements are subject to old AFDC standard earnings disregard policies, while nonexempt people have a more generous earnings disregard.

10. Under AFDC, applicants with earnings received a $90 disregard for work expenses. Recipients with earnings received the $90 disregard, plus an additional $30 disregard plus one-third of remaining earnings for the first four months of earnings. The disregard was then reduced to $90, plus $30 for months 5 through 12. After month 12, recipients with earnings received only a $90 earnings disregard.

11. The 1931 Medicaid program in California uses the $90 disregard for applicants, but has developed new earnings disregards for recipients, which differ from those used by the TANF program.

12. The old AFDC standard disregards the first $175 in child care expenses per month per child if the child is at least two years of age, and $200 per month per child if the child is less than two years old.

13. State Medicaid programs continue to use small disregards for gifts.

14. Connecticut's TANF program counts eight percent of the payment standard when the assistance unit is subject to the time limit, but eight percent of the need standard otherwise.

15. In this sample of 10 states, all continue to exclude the value of homes in assets tests.

16. The old AFDC asset test was to disregard the first $1,500 in equity value of one vehicle and to limit eligible families to no more than $1,000 in countable assets. Countable vehicle assets would include the difference between the equity value of the one vehicle and the $1,500 disregard plus the full equity value of any other vehicles. Vehicles used for commercial purposes were excluded.

17. The poverty expansion program in Colorado uses the asset test for children but not pregnant women.

18. The S-SCHIP programs in Colorado and New Jersey count the benefits received by adult SSI beneficiaries, but not those of child SSI beneficiaries.

19. To be eligible for the TANF program in Arkansas, net income must be less than $223 regardless of family size. Eligibility for the Medicaid 1931 program occurs when net income is less than the payment standard which is $204 for a family of three.

20. States are no longer mandated to provide Medicaid coverage to welfare recipients, although half of the states in our sample told us they automatically enroll TANF recipients into Medicaid. States must enroll all applicants who meet their 1931 eligibility requirements and the 1931 requirements must be as generous as those in place on July 16, 1996 for AFDC recipients.

21. We were restricted to considering three-person households because our data on the need and payment levels that are used to determine income threshold tests in some TANF and many Medicaid 1931 programs pertain only to three-person families.

22. We chose this type of age distribution because the Medicaid poverty expansion programs have mandated income thresholds that differ depending on whether the child is younger or older than six years of age.

23. In Arkansas it is ARKids first, a 1115 waiver program that the state intends to convert into a S-SCHIP program.

Appendix Tables

Appendix Table 1

  Alabama Arkansas California Colorado Connecticut Florida Massachusetts Michigan New Jersey New York
COUNTABLE INCOMEa AND ELIGIBILITY AS OF JANUARY 1, 1999 FOR TWO CHILDREN IN A THREE PERSON FAMILY MOTHER WORKS FULLTIME AT THE MINIMUM WAGE ($993 IN MONTHLY EARNINGS) AND HAS AVERAGE MONTHLY CHILD CARE EXPENSESb
Simulated Countable Income for a Family of Three
TANF $569 $744 $853 $853 $803 $903 $449 $678 $943 $678
1931 $678 $744 $678 $678 $803 $853 $993 $678 $678 $678
Poverty $678 $678 $678 $768 $628 $678 $993 $678 $678 $678
M-SCHIP $678 $678 $678 NP $628 $678 $993 $678 $678 $678
S-SCHIP $993 $943c $993 $563 $628 Healthy Kids: $993 MediKids: $678 $993 $728 $993 $903
Program eligibility
Younger child
(age 3)
Poverty Poverty 1931 Poverty TANF/1931 Poverty 1931 Poverty Poverty Poverty
Older child
(age 9)
Poverty Poverty 1931 Poverty TANF/1931 Poverty 1931 Poverty Poverty Poverty
Source: MPR State Income Eligibility Requirements Database.

Note: NP = No program

aGross income minus any disregards for earnings, child care expenses, child support payments received by the family.

bFamily composition assumes two children ages three and nine, the mother works 40 hours/ week at minimum wage ($5.15/hour), which is equivalent to $993 in monthly earnings or 86 percent of the 1999 Federal poverty level. Average monthly child care expenses of $329/month are based on estimates of the national average child care expenses paid by non-poor households (Casper 1995) and the family receives $100 a month in child support and qualifies for any child support disregard. Family has no other countable income.

cThis income level is for the ARKids First program. The program is currently a 1115 Medicaid Waiver program, but the state plans to convert it into an S-SCHIP program.

Appendix Table 2

  Alabama Arkansas California Colorado Connecticut Florida Massachusetts Michigan New Jersey New York
COUNTABLE INCOMEa AND ELIGIBILITY AS OF JANUARY 1, 1999 FOR TWO CHILDREN IN A THREE PERSON FAMILY MOTHER WORKS FULLTIME AT THE MINIMUM WAGE ($993 IN MONTHLY EARNINGS) AND HAS NO CHILD CARE EXPENSESb
Simulated Countable Income for a Family of Three
TANF $794 $794 $903 $903 $903 $903 $674 $903 $993 $903
1931 $903 $794 $903 $903 $903 $903 $993 $903 $903 $903
Poverty $903 $903 $903 $993 $903 $903 $993 $903 $903 $903
M-SCHIP $903 $903 $903 NP $903 $903 $993 $903 $903 $903
S-SCHIP $993 $993c $993 $993 $903 Healthy Kids: $993 MediKids: $903 $993 $903 $993 $903
Program eligibility
Younger child
(age 3)
Poverty Poverty Poverty Poverty Poverty Poverty 1931 Poverty Poverty Poverty
Older child
(age 9)
Poverty Poverty Poverty Poverty Poverty Poverty 1931 Poverty Poverty Poverty
Source: MPR State Income Eligibility Requirements Database.

Note: NP = No program

aGross income minus any disregards for earnings.

bFamily composition assumes two children ages three and nine, the mother works 40 hours/week at minimum wage ($5.15/hour), which is equivalent to $993 in monthly earnings or 86 percent of the 1999 Federal poverty levels. The family does not qualify for any child care or child support disregards.

cThis income level is for the ARKids First program. The program is currently a 1115 Medicaid Waiver program, but the state plans to convert it into an S-SCHIP program.

Appendix Table 3

  Alabama Arkansas California Colorado Connecticut Florida Massachusetts Michigan New Jersey New York
COUNTABLE INCOMEa AND ELIGIBILITY AS OF JANUARY 1, 1999 FOR TWO CHILDREN IN A THREE PERSON FAMILY MOTHER WORKS FULLTIME AT $7.00 PER HOUR ($1,313 IN MONTHLY EARNINGS) AND HAS AVERAGE MONTHLY CHILD CARE EXPENSESb
Simulated Countable Income for a Family of Three
TANF $826 $1,001 $1,173 $1,173 $1,123 $1,223 $706 $998 $1,263 $998
1931 $998 $1,001 $998 $998 $1,123 $1,173 $1,313 $998 $998 $998
Poverty $998 $998 $998 $1,088 $948 $998 $1,313 $998 $998 $998
M-SCHIP $998 $998 $998 NP $948 $998 $1,313 $998 $998 $998
S-SCHIP $1,313 $1,263c $1,313 $884 $948 Healthy Kids: $1,313 MediKids: $998 $1,31 $1,048 $1,313 $1,223
Program eligibility
Younger child
(age 3)
Poverty Poverty Poverty Poverty Poverty Poverty 1931 Poverty Poverty Poverty
Older child
(age 9)
Poverty Poverty Poverty Poverty Poverty Poverty 1931 Poverty Poverty Poverty
Source: MPR State Income Eligibility Requirements Database.

Note: NP = No program

aGross income minus any disregards for earnings, child care expenses, child support payments received by the family.

bFamily composition assumes two children ages three and nine, the mother works 40 hours/ week at $7/hour, which is equivalent to $1,313 in monthly earnings or 114 percent of the 1999 Federal poverty level. Average monthly child care expenses of $329/month are based on estimates of the national average child care expenses paid by non-poor households (Casper 1995) and the family receives $100 a month in child support and qualifies for any child support disregard. Family has no other countable income.

cThis income level is for the ARKids First program. The program is currently a 1115 Medicaid Waiver program, but the state plans to convert it into an S-SCHIP program.

Appendix Table 4

  Alabama Arkansas California Colorado Connecticut Florida Massachusetts Michigan New Jersey New York
COUNTABLE INCOMEa AND ELIGIBILITY AS OF JANUARY 1, 1999 FOR TWO CHILDREN IN A THREE PERSON FAMILY MOTHER WORKS FULLTIME AT $7.00 PER HOUR ($1,313 IN MONTHLY EARNINGS) AND HAS NO CHILD CARE EXPENSESb
Simulated Countable Income for a Family of Three
TANF $1,051 $1,051 $1,223 $1,223 $1,223 $1,223 $931 $1,223 $1,313 $1,223
1931 $1,223 $1,051 $1,223 $1,223 $1,223 $1,223 $1,313 $1,223 $1,223 $1,223
Poverty $1,223 $1,223 $1,223 $1,313 $1,223 $1,223 $1,313 $1,223 $1,223 $1,223
M-SCHIP $1,223 $1,223 $1,223 NP $1,223 $1,223 $1,313 $1,223 $1,223 $1,223
S-SCHIP $1,313 $1,313c $1,313 $1,313 $1,223 Healthy Kids: $1,313 MediKids: $1,223 $1,313 $1,223 $1,313 $1,223
Program eligibility
Younger child
(age 3)
Poverty Poverty Poverty Poverty Poverty Poverty 1931 Poverty Poverty Poverty
Older child
(age 9)
S-SCHIP ARKids S-SCHIP S-SCHIP Poverty S-SCHIP 1931 Poverty M-SCHIP S-SCHIP
Source: MPR State Income Eligibility Requirements Database.

Note: NP = No program

aGross income minus any disregards for earnings.

bFamily composition assumes two children ages three and nine, the mother works 40 hours/week at $7/hour, which is equivalent to $1,313 in monthly earnings or 114 percent of the 1999 Federal poverty level.. The family does not qualify for any child care or child support disregards.

cThis income level is for the ARKids First program. The program is currently a 1115 Medicaid Waiver program, but the state plans to convert it into an S-SCHIP program.

Appendix Table 5

  Alabama Arkansas California Colorado Connecticut Florida Massachusetts Michigan New Jersey New York
COUNTABLE INCOMEa AND ELIGIBILITY AS OF JANUARY 1, 1999 FOR A FIVE YEAR OLD CHILD IN A THREE PERSON FAMILY WITH TWO EARNERS AND MONTHLY GROSS INCOME OF $1,157 (100 percent of 1999 FPL) AND AVERAGE MONTHLY CHILD CARE EXPENSESb
Simulated Countable Income for a Family of Three with Two Earners
TANF $750 $925 $977 $977 $977 $977 $630 $802 $1,157 $802
1931 $802 $925 $802 $802 $977 $977 $1,157 $802 $802 $802
Poverty $802 $802 $802 $982 $802 $802 $1,157 $802 $802 $802
M-SCHIP $802 $802 $802 NP $802 $802 $1,157 $802 $802 $802
S-SCHIP $1,157 $1,157c $1,157 $827 $802 Healthy Kids: $1,157 MediKids: $802 $1,157 $802 $1,157 $977
Program eligibility
5 year old Poverty Poverty Poverty Poverty Poverty Poverty 1931 Poverty Poverty Poverty
Source: MPR State Income Eligibility Requirements Database.

Note:
NP = No program
FPL=Federal poverty level

aGross income minus any disregards for earnings and child care expenses.

bFamily composition assumes two earners and average monthly child care expenses of $329/month are based on estimates of the national average for child care expenses paid by non-poor households (Casper 1995).

cThis income level is for the ARKids First program. The program is currently a 1115 Medicaid Waiver program, but the state plans to convert it into an S-SCHIP program.

Appendix Table 6

  Alabama Arkansas California Colorado Connecticut Florida Massachusetts Michigan New Jersey New York
COUNTABLE INCOMEa AND ELIGIBILITY AS OF JANUARY 1, 1999 FOR A FIVE YEAR OLD CHILD IN A THREE PERSON FAMILY WITH TWO EARNERS AND MONTHLY GROSS INCOME OF $1,735 (150 percent of 1999 FPL) AND AVERAGE MONTHLY CHILD CARE EXPENSESb
Simulated Countable Income for a Family of Three with Two Earners
TANF $1,213 $1,388 $1,555 $1,555 $1,555 $1,555 $1,093 $1,380 $1,735 $1,380
1931 $1,380 $1,388 $1,380 $1,380 $1,555 $1,555 $1,735 $1,380 $1,380 $1,380
Poverty $1,380 $1,380 $1,380 $1,560 $1,380 $1,380 $1,735 $1,380 $1,380 $1,380
M-SCHIP $1,380 $1,380 $1,380 NP $1,380 $1,380 $1,735 $1,380 $1,380 $1,380
S-SCHIP $1,735 $1,735c $1,735 $1,406 $1,380 Healthy Kids: $1,735 MediKids: $1,350 $1,735 $1,380 $1,735 $1,555
Program eligibility
5 year old Poverty Poverty Poverty S-SCHIP Poverty Poverty M-SCHIP Poverty Poverty Poverty
Source: MPR State Income Eligibility Requirements Database.

Note:
NP = No program
FPL=Federal poverty level

aGross income minus any disregards for earnings and child care expenses.

bFamily composition assumes two earners and average monthly child care expenses of $329/month are based on estimates of the national average child care expenses paid by non-poor households (Casper 1995).

cThis income level is for the ARKids First program. The program is currently a 1115 Medicaid Waiver program, but the state plans to convert it into an S-SCHIP program.

Appendix Table 7

  Alabama Arkansas California Colorado Connecticut Florida Massachusetts Michigan New Jersey New York
COUNTABLE INCOMEa AND ELIGIBILITY AS OF JANUARY 1, 1999 FOR A FIVE YEAR OLD CHILD IN A THREE PERSON FAMILY WITH TWO EARNERS AND MONTHLY GROSS INCOME OF $2,313 (200 percent of 1999 FPL) AND AVERAGE MONTHLY CHILD CARE EXPENSESb
Simulated Countable Income for a Family of Three with Two Earners
TANF $1,676 $1,851 $2,133 $2,133 $2,133 $2,133 $1,556 $1,958 $2,313 $1,958
1931 $1,958 $1,851 $1,958 $1,958 $2,133 $2,133 $2,313 $1,958 $1,958 $1,958
Poverty $1,958 $1,958 $1,958 $2,138 $1,958 $1,958 $2,313 $1,958 $1,958 $1,958
M-SCHIP $1,958 $1,958 $1,958 NP $1,958 $1,958 $2,313 $1,958 $1,958 $1,958
S-SCHIP $2,313 $2,313c $2,313 $1,984 $1,958 Healthy Kids: $2,313 MediKids: $1,958 $2,313 $1,958 $2,313 $2,133
Program eligibility
5 year old S-SCHIP ARKids S-SCHIP S-SCHIP Poverty S-SCHIP S-SCHIP S-SCHIP S-SCHIP S-SCHIP
Source: MPR State Income Eligibility Requirements Database.

Note:
NP = No program
FPL=Federal poverty level

aGross income minus any disregards for earnings and child care expenses.

bFamily composition assumes two earners and average monthly child care expenses of $329/month are based on estimates of the national average child care expenses paid by non-poor households (Casper 1995).

cThis income level is for the ARKids First program. The program is currently a 1115 Medicaid Waiver program, but the state plans to convert it into an S-SCHIP program.

Appendix Table 8

  Alabama Arkansas California Colorado Connecticut Florida Massachusetts Michigan New Jersey New York
COUNTABLE INCOMEa AND ELIGIBILITY AS OF JANUARY 1, 1999 FOR A FIVE YEAR OLD CHILD IN A THREE PERSON FAMILY WITH TWO EARNERS AND MONTHLY GROSS INCOME OF $2,892 (250 percent of 1999 FPL) AND AVERAGE MONTHLY CHILD CARE EXPENSESb
Simulated Countable Income for a Family of Three with Two Earners
TANF $2,138 $2,313 $2,712 $2,712 $2,712 $2,712 $2,018 $2,537 $2,892 $2,537
1931 $2,537 $2,313 $2,537 $2,537 $2,712 $2,712 $2,892 $2,537 $2,537 $2,537
Poverty $2,537 $2,537 $2,537 $2,717 $2,537 $2,537 $2,892 $2,537 $2,537 $2,537
M-SCHIP $2,537 $2,537 $2,537 NP $2,537 $2,537 $2,892 $2,537 $2,537 $2,537
S-SCHIP $2,892 $2,892c $2,892 $2,562 $2,537 Healthy Kids: $2,892 MediKids: $2,537 $2,892 $2,537 $2,892 $2,712
Program eligibility
5 year old Not eligible Not eligible Not eligible Not eligible S-SCHIP Not eligible Not eligible Not eligible Not eligible Not eligible
Source: MPR State Income Eligibility Requirements Database.

Note:
NP = No program
FPL=Federal poverty level

aGross income minus any disregards for earnings and child care expenses.

bFamily composition assumes two earners and average monthly child care expenses of $329/month are based on estimates of the national average child care expenses paid by non-poor households (Casper 1995).

cThis income level is for the ARKids First program. The program is currently a 1115 Medicaid Waiver program, but the state plans to convert it into an S-SCHIP program.

Appendix Table 9

  Alabama Arkansas California Colorado Connecticut Florida Massachusetts Michigan New Jersey New York
COUNTABLE INCOMEa AND ELIGIBILITY AS OF JANUARY 1, 1999 FOR A 17 YEAR OLD CHILD IN A THREE PERSON FAMILY WITH TWO EARNERS AND MONTHLY GROSS INCOME OF $1,157 (100 percent of 1999 FPL)b
Simulated Countable Income for a Family of Three with Two Earners
TANF $925 $925 $977 $977 $977 $977 $805 $977 $1,157 $977
1931 $977 $925 $977 $977 $977 $977 $1,157 $977 $977 $977
Poverty $977 $977 $977 $1,157 $977 $977 $1,157 $977 $977 $977
M-SCHIP $977 $977 $997 NP $977 $977 $1,157 $977 $977 $977
S-SCHIP $1,157 $1,157c $1,157 $1,157 $977 Healthy Kids: $1,157 MediKids: $977 $1,157 $977 $1,157 $977
Program eligibility
5 year old M-SCHIP Poverty M-SCHIP S-SCHIP Poverty M-SCHIP 1931 Poverty M-SCHIP M-SCHIP
Source: MPR State Income Eligibility Requirements Database.

Note:
NP = No program
FPL=Federal poverty level

aGross income minus any disregards for earnings and child care expenses.

bFamily composition assumes two earners.

cThis income level is for the ARKids First program. The program is currently a 1115 Medicaid Waiver program, but the state plans to convert it into an S-SCHIP program.

Appendix Table 10

  Alabama Arkansas California Colorado Connecticut Florida Massachusetts Michigan New Jersey New York
COUNTABLE INCOMEa AND ELIGIBILITY AS OF JANUARY 1, 1999 FOR A 17 YEAR OLD CHILD IN A THREE PERSON FAMILY WITH TWO EARNERS AND MONTHLY GROSS INCOME OF $1,735 (150 percent of 1999 FPL)b
Simulated Countable Income for a Family of Three with Two Earners
TANF $1,388 $1,388 $1,555 $1,555 $1,555 $1,555 $1,268 $1,555 $1,735 $1,555
1931 $1,555 $1,388 $1,555 $1,555 $1,555 $1,555 $1,735 $1,555 $1,555 $1,555
Poverty $1,555 $1,555 $1,555 $1,735 $1,555 $1,555 $1,735 $1,555 $1,555 $1,555
M-SCHIP $1,555 $1,555 $1,555 NP $1,555 $1,555 $1,735 $1,555 $1,555 $1,555
S-SCHIP $1,735 $1,735c $1,735 $1,735 $1,555 Healthy Kids: $1,735 MediKids: $1,555 $1,735 $1,555 $1,735 $1,555
Program eligibility
17 year old S-SCHIP ARKids S-SCHIP S-SCHIP M-SCHIP S-SCHIP M-SCHIP M-SCHIP S-SCHIP S-SCHIP
Source: MPR State Income Eligibility Requirements Database.

Note:
NP = No program
FPL=Federal poverty level

aGross income minus any disregards for earnings and child care expenses.

bFamily composition assumes two earners.

cThis income level is for the ARKids First program. The program is currently a 1115 Medicaid Waiver program, but the state plans to convert it into an S-SCHIP program.

Appendix Table 11

  Alabama Arkansas California Colorado Connecticut Florida Massachusetts Michigan New Jersey New York
COUNTABLE INCOMEa AND ELIGIBILITY AS OF JANUARY 1, 1999 FOR A 17 YEAR OLD CHILD IN A THREE PERSON FAMILY WITH TWO EARNERS AND MONTHLY GROSS INCOME OF $2,313 (200 percent of 1999 FPL)b
Simulated Countable Income for a Family of Three with Two Earners
TANF $1,851 $1,851 $2,133 $2,133 $2,133 $2,133 $1,731 $2,133 $2,313 $2,133
1931 $2,133 $1,851 $2,133 $2,133 $2,133 $2,133 $2,313 $2,133 $2,133 $2,133
Poverty $2,133 $2,133 $2,133 $2,313 $2,133 $2,133 $2,313 $2,133 $2,133 $2,133
M-SCHIP $2,133 $2,133 $2,133 NP $2,133 $2,133 $2,313 $2,133 $2,133 $2,133
S-SCHIP $2,313 $2,313c $2,313 $2,313 $2,133 Healthy Kids: $2,313 MediKids: $2,133 $2,313 $2,133 $2,313 $2,133
Program eligibility
17 year old S-SCHIP ARKids S-SCHIP S-SCHIP M-SCHIP S-SCHIP S-SCHIP S-SCHIP S-SCHIP S-SCHIP
Source: MPR State Income Eligibility Requirements Database.

Note:
NP = No program
FPL=Federal poverty level

aGross income minus any disregards for earnings and child care expenses.

bFamily composition assumes two earners.

cThis income level is for the ARKids First program. The program is currently a 1115 Medicaid Waiver program, but the state plans to convert it into an S-SCHIP program.

Appendix Table 12

  Alabama Arkansas California Colorado Connecticut Florida Massachusetts Michigan New Jersey New York
COUNTABLE INCOMEa AND ELIGIBILITY AS OF JANUARY 1, 1999 FOR A 17 YEAR OLD CHILD IN A THREE PERSON FAMILY WITH TWO EARNERS AND MONTHLY GROSS INCOME OF $2,892 (250 percent of 1999 FPL)b
Simulated Countable Income for a Family of Three with Two Earners
TANF $2,313 $2,313 $2,712 $2,712 $2,712 $2,712 $2,193 $2,712 $2,892 $2,712
1931 $2,712 $2,313 $2,712 $2,712 $2,712 $2,712 $2,892 $2,712 $2,712 $2,712
Poverty $2,712 $2,712 $2,712 $2,712 $2,712 $2,712 $2,892 $2,712 $2,712 $2,712
M-SCHIP $2,712 $2,712 $2,712 NP $2,712 $2,712 $2,892 $2,712 $2,712 $2,712
S-SCHIP $2,892 $2,892c $2,892 $2,892 $2,712 Healthy Kids: $2,892 MediKids: $2,712 $2,892 $2,712 $2,892 $2,712
Program eligibility
17 year old Not eligible Not eligible Not eligible Not eligible S-SCHIP Not eligible Not eligible Not eligible Not eligible Not eligible
Source: MPR State Income Eligibility Requirements Database.

Note:
NP = No program
FPL=Federal poverty level

aGross income minus any disregards for earnings and child care expenses.

bFamily composition assumes two earners.

cThis income level is for the ARKids First program. The program is currently a 1115 Medicaid Waiver program, but the state plans to convert it into an S-SCHIP program.

References

Administration for Children and Families. "TANF Program, First Annual Report to Congress." Washington, DC: 1998.

Casper, L. "What does it cost to mind our preschoolers?" Current Population Reports. (Series P70-52). Washington, DC: U.S. Bureau of the Census. September 1995.

National Academy for State Health Policy. "Charting CHIP: Report of the First National Survey of the Children's Health Insurance Program." Portland, ME, April 1999.

Schirm, Allen L., and John L. Czajka. "State Estimates of Uninsured Children, January 1998." Draft Report submitted to the Assistant Secretary of Planning and Evaluation in the Office of the Secretary. Washington, DC: Mathematica Policy Research, Inc., March 8, 2000.

Location- & Geography-Based Data
State Data
Program
Medicaid | Children's Health Insurance Program (CHIP)