Saturday, 15 January 2005 - 4:00 PM

This presentation is part of: Health Services

Who Leaves Medicaid without Health Insurance?

This study was longitudinal in nature and explored specifically the reasons why some Medicaid users as well as TANF recipients had ended their enrollment in Medicaid. The study comprised a secondary data analysis of responses to the Survey of Income and Program Participation (SIPP) 1996 Panel. Only Medicaid recipients who were age 18-64, able-bodied, parents of dependent children, and not self-employed were considered in the present study. The recipients were from 45 states and the District of Columbia. The entire sample of Medicaid spells for data analysis consisted of 42,643 person-months, representing 3,898 spells meeting all of the established criteria. In an effort to understand the impact of TANF policies on Medicaid use, a sub-sample was extracted from the data for additional analysis. The sub-sample consisted of Medicaid spells that began after the launching of TANF, a date that varied among the states studied, and it involved TANF recipients alone. This sub-sample of Medicaid spells contained 12,111 person-months played out in 785 spells.

The outcome variable for the study was the medical insured status of Medicaid enrollees in each month. Those who reported their enrollment for Medicaid in a month were labeled Medicaid enrollees. Two types of exit from Medicaid figured in the study. Exit to uninsured status was recorded when a Medicaid enrollee reported leaving Medicaid and becoming uninsured. Exit to privately insured status was noted if a Medicaid enrollee reported leaving Medicaid and the subsequent exclusive use of private medical insurance. No exit from Medicaid was recorded when an individual exhibited enrollment in Medicaid over two consecutive months. Six variables groups were established for the study: Medicaid use history, demographic characteristics, human capital factors, economic factors, welfare receipt history, and welfare policies.

Employing event history analysis and multinomial logistic regression, the study found that a high unemployment rate predicted exits from Medicaid by individuals who would become uninsured. Individuals who were white and employed part-time were likely to become uninsured. It found, furthermore, that individuals with relatively more education and with earnings exceeding the poverty threshold tended to exit Medicaid to be covered by private health insurance. Married persons and African-Americans with full-time jobs and earnings above the poverty line were the most likely to gain private coverage. The study also determined that welfare recipients enrolled for Medicaid were likely to stay enrolled in Medicaid, while enrolled non-recipients of welfare were likely to exit Medicaid. For the period following the launch of TANF (Temporary Assistance to Needy Families), continued use of Medicaid was likely among users of Medicaid programs. Among those who did exit Medicaid, 50% became uninsured. The main reason such individuals left Medicaid, according to the study, was because they had disenrolled from TANF. The impact of leaving TANF upon becoming uninsured, in turn, was moderated by restrictive and punitive TANF policies. TANF recipients who were unemployed single mothers and neither African-American nor Hispanic were likely to continue being covered by Medicaid. Implications for policy were also discussed.

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