Effects of Medicaid Automatic Enrollment on Disparities in Insurance Coverage and Caregiver Burden for Children with Special Health Care Needs

Rennane, Stephanie; Dick, Andrew W.

doi:10.1177/10775587221106116

Cited by 5 publications

(8 citation statements)

References 57 publications

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“…In the version of the model with the state indicators, automatic enrollment is associated with a 3.4 percentage point decline in the likelihood of being uninsured for the entire year (CI −5.4 to −1.3), and a 6.0 percentage point increase in the probability of having Medicaid in the year (CI 1.9 to 10.0). These results are broadly consistent with prior work (though different specifications) on this topic using NS‐CSHCN 20 …”

Section: Introductionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

“…Our sample includes 9325 children receiving SSI from three survey waves (2001, 2005–2006, and 2009–2010). Rennane and Dick 2023 provides more detail on using the NS‐CSHCN for analyzing children on SSI and Medicaid 20 . The NS‐CSHCN has state identifiers but ends in 2010.…”

Section: Introductionmentioning

confidence: 99%

“…Prior work leveraging this state‐level variation found SSI‐Medicaid automatic enrollment led to declines in the uninsured rate for SSI children and declines in caregiver burden for their families. 20 Using a different data source, this paper offers two new contributions. First, we offer new evidence about the relationship between SSI‐Medicaid automatic enrollment and insurance coverage for children after the passage of the ACA.…”

Section: Introductionmentioning

confidence: 99%

“…Rennane and Dick 2023 provides more detail on using the NS‐CSHCN for analyzing children on SSI and Medicaid. 20 The NS‐CSHCN has state identifiers but ends in 2010. The NSCH was redesigned in 2016 to incorporate information from NS‐CSHCN but does not include SSI receipt from 2016 to 2021.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Insurance coverage during transitions: Evidence from Medicaid automatic enrollment for children receiving supplemental security income

Rennane,

Sobol,

Stein

et al. 2023

Health Services Research

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ObjectivesTo analyze relationships between Medicaid automatic enrollment for child Supplemental Security Income (SSI) recipients and health insurance coverage during transitions.Data Sources and Study SettingMedical Expenditure Panel Study, 2000–2020 and National Survey for Children with Special Health Care Needs, 2001–2010.Study DesignLeveraging variation in SSI‐Medicaid automatic enrollment status across regions and over time, we estimate a regression model to quantify associations between automatic enrollment and insurance coverage. We validate our findings in the NS‐CSHCN.Data CollectionOur sample includes children receiving SSI for a disability. We also analyze a subsample of children newly enrolled in SSI.Principal FindingsAutomatic enrollment is associated with a statistically significant increase in insurance coverage. Expanding automatic enrollment to all states is associated with increases in Medicaid enrollment of 3% (CI 0.9%–6.7%) among all SSI children and 7% (CI 1.1%–13.9%) among children newly enrolled in SSI. We find similar decreases in uninsurance. Analysis in the NS‐CSHCN replicates these findings.ConclusionsMedicaid automatic enrollment policies are associated with increased insurance coverage for SSI children, particularly those transitioning into the program. Medicaid policy defaults could play an important role in reducing administrative burdens to improve children's coverage and access to care.

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Section: Introductionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Insurance coverage during transitions: Evidence from Medicaid automatic enrollment for children receiving supplemental security income

Rennane,

Sobol,

Stein

et al. 2023

Health Services Research

Self Cite

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Associations Between Annual Medicare Part D Low-Income Subsidy Loss and Prescription Drug Spending and Use

Fung,

Price,

Cheng

et al. 2024

JAMA Health Forum

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ImportanceThe Medicare Part D Low Income Subsidy (LIS) program provides millions of beneficiaries with drug plan premium and cost-sharing assistance. The extent to which LIS recipients experience subsidy losses with annual redetermination cycles and the resulting associations with prescription drug affordability and use are unknown.ObjectiveTo examine how frequently annual LIS benefits are lost among Medicare Part D beneficiaries and how this is associated with prescription drug use and out-of-pocket costs.Design, Setting, and ParticipantsIn this cohort study of Medicare Part D beneficiaries from 2007 to 2018, annual changes in LIS recipients among those automatically deemed eligible (eg, due to dual eligibility for Medicare and Medicaid) and nondeemed beneficiaries who must apply for LIS benefits were analyzed using Medicare enrollment and Part D event data. Subsidy losses were classified in 4 groups: temporary losses (&lt;1 year); extended losses (≥1 year); subsidy reductions (change to partial LIS); and disenrollment from Medicare Part D after subsidy loss. Temporary losses could more likely represent subsidy losses among eligible beneficiaries. Multinomial logit models were used to examine associations between beneficiary characteristics and subsidy loss; linear regression models were used to compare changes in prescription drug cost and use in the months after subsidy losses vs before. Analyses were conducted between November 2022 and November 2023.ExposureSubsidy loss at the beginning of each year among subsidy recipients in December of the prior year.Main Outcomes and MeasuresThe main outcomes were out-of-pocket costs and prescription drug fills overall and for 4 classes: antidiabetes, antilipid, antidepressant, and antipsychotic drugs.ResultsIn 2008, 731 070 full LIS beneficiaries (17%) were not deemed automatically eligible (39% were aged &lt;65 years; 59% were female). Nearly all beneficiaries deemed automatically eligible (≥99%) retained the subsidy annually from 2007 to 2018, compared with 78% to 84% of nondeemed beneficiaries. Among nondeemed beneficiaries, disabled individuals younger than 65 years and racial and ethnic minority groups were more likely to have temporary subsidy losses vs none. Temporary losses were associated with an average 700% increase in out-of-pocket drug costs (+$52.72/mo [95% CI, 52.52-52.92]) and 15% reductions in prescription fills (−0.58 fills/mo [95% CI, −0.59 to −0.57]) overall. Similar changes were found for antidiabetes, antilipid, antidepressant, and antipsychotic prescription drug classes. Beneficiaries who retained their subsidy had few changes.Conclusions and RelevanceThe conclusions of this cohort study suggest that efforts to help eligible beneficiaries retain Medicare Part D subsidies could improve drug affordability, treatment adherence, and reduce disparities in medication access.

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Pandemic‐era changes to medicaid enrollment and funding: Implications for future policy and research

Dague,

Ukert

2023

J Policy Anal Manage

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The COVID‐19 public health emergency led to federal legislation that changed the landscape of Medicaid coverage for low‐income people in the United States. Policy responses led to a surge in Medicaid caseloads due to new rules preventing Medicaid disenrollment, and total Medicaid enrollment increased more from 2020 to 2023 than the net increase in insurance coverage from 2013 to 2017 following the Affordable Care Act's implementation. It is crucial for scholars and practitioners to understand the implications of this continuous coverage policy and its 2023–2024 unwinding. This paper provides an overview of Medicaid enrollment, renewal, and funding policies, highlighting how policy changed during and immediately following the acute phase of the pandemic; describes enrollment increases and their composition; reviews relevant literature; and identifies key areas for research. By examining this unprecedented period in Medicaid, we can inform future policy decisions and optimize safety net programs to be effective under a broad set of circumstances.

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Effects of Medicaid Automatic Enrollment on Disparities in Insurance Coverage and Caregiver Burden for Children with Special Health Care Needs

Cited by 5 publications

References 57 publications

Insurance coverage during transitions: Evidence from Medicaid automatic enrollment for children receiving supplemental security income

Insurance coverage during transitions: Evidence from Medicaid automatic enrollment for children receiving supplemental security income

Associations Between Annual Medicare Part D Low-Income Subsidy Loss and Prescription Drug Spending and Use

Pandemic‐era changes to medicaid enrollment and funding: Implications for future policy and research

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