IMPORTANCEAfter the federal public health emergency was declared in March 2020, states could qualify for increased federal Medicaid funding if they agreed to maintenance of eligibility (MOE) provisions, including a continuous coverage provision. The implications of MOE provisions for total Medicaid enrollment are unknown. OBJECTIVE To examine observed increases in Medicaid enrollment and identify the underlying roots of that growth during the first 7 months of the COVID-19 public health emergency in Wisconsin. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study compared changes in Wisconsin Medicaid enrollment from March through September 2020 with predicted changes based on previous enrollment patterns (January 2015-September 2019) and early pandemic employment shocks. The participants included enrollees in full-benefit Medicaid programs for nonelderly, nondisabled beneficiaries in Wisconsin from March through September 2020. Individuals were followed up monthly as they enrolled in, continued in, and disenrolled from Medicaid. Participants were considered to be newly enrolled if they enrolled in the program after being not enrolled for at least 1 month, and they were considered disenrolled if they left and were not reenrolled within the next month. EXPOSURES Continuous coverage provision beginning in March 2020; economic disruption from pandemic between first and second quarters of 2020. MAIN OUTCOMES AND MEASURES Actual vs predicted Medicaid enrollment, new enrollment, disenrollment, and reenrollment. Three models were created (Medicaid enrollment with no pandemic, Medicaid enrollment with pandemic economic circumstances, and longer Medicaid enrollment with a pandemic-induced recession), and a 95% prediction interval was used to express uncertainty in enrollment predictions. RESULTS The study estimated ongoing Medicaid enrollment in March 2020 for 792 777 enrollees (mean [SD] age, 20.6 [16.5] years; 431 054 [54.4%] women; 213 904 [27.0%] experiencing an employment shock) and compared that estimate with actual enrollment totals. Compared with a model of enrollment based on past data and incorporating the role of recent employment shocks,most ongoing excess enrollment was associated with MOE provisions rather than enrollment of newly eligible beneficiaries owing to employment shocks. After 7 months, overall enrollment had increased to 894 619, 11.1% higher than predicted (predicted enrollment 805 130; 95% prediction interval 767 991-843 086). Decomposing higher-than-predicted retention, most enrollment was among beneficiaries who, before the pandemic, likely would have disenrolled within 6 months, although a substantial fraction (30.4%) was from reduced short-term disenrollment.

Fertility rates significantly fell over the last decades in Latin America. In order to assess the extent to which these changes contributed to the observed reduction in income poverty and inequality, we apply microeconometric decomposition to microdata from national household surveys from seven Latin American countries. We find that changes in fertility rates were associated with a nonnegligible reduction in inequality and poverty in the region. The main channel was straightforward: lower fertility implied smaller families and hence larger per capita incomes. Lower fertility also fostered labor force participation, especially among women, which contributed to the reduction of poverty and inequality in most countries, although the size of this effect was smaller.

ResumenEn lasúltimas décadas, los países de América Latina experimentaron una reducción en el número de hijos promedio por hogar, lo cual no se dio en forma uniforme a lo largo de la distribución del ingreso. Este trabajo busca cuantificar el impacto distributivo de los cambios en las decisiones de fecundidad en cinco países de América Latina: Argentina, Brasil, Chile, El Salvador y Uruguay. Utilizando encuestas de hogares, y mediante metodologías de microdescomposición, se desarrollan escenarios contrafácticos de la distribución del ingreso de forma de descomponer el efecto asociado de los cambios en las decisiones de fecundidad. Los resultados muestran que los cambios en las decisiones de fecundidad tuvieron un efecto igualador sobre la distribución del ingreso, junto con un efecto reductor de la pobreza. AbstractIn recent decades, Latin America experienced a reduction in the average number of children per household, which did not occur uniformly along the income distribution.This work seeks to quantify the distributional impact of changes in fertility decisions in five Latin American countries: Argentina, Brazil, Chile, El Salvador and Uruguay.Using household surveys, and through microdecomposition methodologies, counterfactual scenarios of income distribution are developed to decompose the associated effect of changes in fertility decisions. The results show that changes in fertility decisions had an equalizing effect on income distribution, together with the effect of reducing poverty.