Barriers to Medicaid Enrollment: Who Is at Risk?

Stuber, Jennifer; Bradley, Elizabeth

doi:10.2105/ajph.2002.006254

Cited by 51 publications

(40 citation statements)

References 14 publications

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“…During this 1-time increase, only 22% of children who moved to public insurance could have been classified as being crowded out, substantially less than previous estimates 5,8,26 Often overlooked in the crowd-out debate is the fact that Medicaid serves as a safety net for children and families facing falling incomes. One of the original crowd-out studies is repeatedly cited for the finding that 50% of children enrolling in Medicaid after a coverage expansion would otherwise have had or were crowded out of private coverage 27 (subsequent studies have reported a wide range of crowd-out estimates 4---6 seen by the population shift in Figure 2. With more children in lower-income households, there was likely a greater need for public insurance as a safety net.…”

Section: Discussionmentioning

confidence: 99%

“…Crowd-out levels also vary depending on individual state policies, structure of Medicaid and CHIP programs, and barriers to enrollment. 13,27 The general trend nationwide is toward more children being covered by public programs, similar to Ohio. 28 We believe that our core finding that the movement of children toward public programs being driven by changing economics as opposed to increased crowd-out is likely generalizable across the United States.…”

Section: Limitationsmentioning

confidence: 99%

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Children’s Insurance Coverage and Crowd-Out Through the Recession: Lessons From Ohio

Muhlestein

Seiber

2015

Am J Public Health

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Objectives. We estimated changes in children’s insurance status (publicly insured, privately insured, or uninsured) and crowd-out rates during the 2007 to 2009 US recession in Ohio. Methods. We conducted an estimate of insurance coverage from statewide, randomized telephone surveys in 2004, 2008, 2010, and 2012. We estimated crowd-out by using regression discontinuity. Results. From 2004 to 2012, private insurance rates dropped from 67% to 55% and public rates grew from 28% to 40%, with no change in the uninsured rate for children. Despite a 12.0% decline in private coverage and a corresponding 12.6% increase in public coverage, we found no evidence that crowd-out increased during this period. Conclusions. Children, particularly those with household incomes lower than 400% of the federal poverty level, were enrolled increasingly in public insurance rather than private coverage. Near the Medicaid eligibility threshold, this is not from an increase in crowd-out. An alternative explanation for the increase in public coverage would be the decline in incomes for households with children.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Children’s Insurance Coverage and Crowd-Out Through the Recession: Lessons From Ohio

Muhlestein

Seiber

2015

Am J Public Health

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“…Absent some underlying health concern, it is unlikely that significant numbers of parents would intentionally lower their income to gain Medicaid for their children, particularly when the median price of insuring a child on an individual plan is less than $100 per month (eHealth, 2011, p. 13). Additionally, there are significant process barriers to enrollment in Medicaid (Stuber & Bradley, 2005) which make enrollment in the program an uncertainty; it is unlikely Muhlestein, D. B., Seiber, E. E.…”

Section: E7mentioning

confidence: 99%

State Variability in Children’s Medicaid/CHIP Crowd-Out Estimates

Muhlestein

Seiber

2013

MMRR

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Background: Health insurance crowd-out occurs when individuals enrolled in a public health insurance plan would have enrolled in a private plan but for the public option. The crowding-out of private insurance is often used to criticize state Medicaid and Children's Health Insurance Program (CHIP) expansion, as already insured children move their coverage to the states at the public's expense. A difficulty in discussing crowd-out comes from inconsistent estimates. Previous work focusing on the expansion of public programs has led to estimates ranging from 0% to 50% of the children newly insured on public plans being crowded-out. Methods:We apply a regression discontinuity approach to estimate how many children near the state Medicaid/CHIP threshold are crowded-out of private insurance. This approach allows estimates of crowd-out near the eligibility threshold independent of any expansion. Data from the American Community Survey's yearly survey of American households allows for state-level estimates of crowd-out. Results:We find considerable heterogeneity in the crowd-out that occurs in each state, ranging from no crowd-out to over 18% in states with similar eligibility thresholds. Additionally, we found that as state eligibility thresholds increase, children are less likely to be crowded-out.Discussion: This research indicates that national estimates of crowd-out are inappropriate, as statespecific Medicaid and CHIP programs have state-specific crowd-out. Additionally, it indicates that wealthier families that are eligible for public insurance are less likely to switch from private to public coverage than families earning less. Future work should identify reasons for the heterogeneity among states.

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“…In addition, unlike the situation with the BCCPTA, other eligibility groups in many states deal with a long and cumbersome process that requires applicants to locate different documentation necessary to verify the value of their resources. The process itself can discourage completion of the application even if people are actually eligible (Hill and Lutzky 2003;Stuber and Bradley 2005). Under the Georgia BCCPTA, income is verified by self-report and indeed, in the beginning years, there was not an assessment of financial eligibility if screened by a non-NBCCEDP provider.…”

Section: Introductionmentioning

confidence: 99%

Medicaid Enrollment at Early Stage of Disease: The Breast and Cervical Cancer Prevention and Treatment Act in Georgia

Chien

Adams

Zhou

2011

INQUIRY

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This study linked data from the Georgia Comprehensive Cancer Registry to Medicaid enrollment and claims to test whether the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA), which provided a new and quicker pathway to Medicaid eligibility for low-income breast cancer patients, led to more patients enrolling at an early stage of disease. Results based on difference-in-differences analysis indicated that Georgia's BCCPTA increased by 11 percentage points the probability of breast cancer patients enrolling in Medicaid at an early stage (p = .024). This effect could mean more treatment options and higher survival rates for these patients.

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Barriers to Medicaid Enrollment: Who Is at Risk?

Abstract: Findings highlight target groups for whom additional outreach and additional simplification policies may be most needed.

Cited by 51 publications

References 14 publications

Children’s Insurance Coverage and Crowd-Out Through the Recession: Lessons From Ohio

Children’s Insurance Coverage and Crowd-Out Through the Recession: Lessons From Ohio

State Variability in Children’s Medicaid/CHIP Crowd-Out Estimates

Medicaid Enrollment at Early Stage of Disease: The Breast and Cervical Cancer Prevention and Treatment Act in Georgia

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