Evaluating the effect of Medicaid and state children's health insurance program expansions.

摘要

Title XXI of the Balanced Budget Act of 1997 resulted in increased eligibility limits for children in all 50 states. Under Title XXI, states receive enhanced federal matching rates to insure low-income children who would otherwise not qualify for Medicaid. States have the option of expanding eligibility through Medicaid expansions, through the creation of state programs, separate from Medicaid, or from a combination of the two. The key differences between Medicaid and the state programs are that the state programs have more freedom to impose minimal cost-sharing measures and to require that children be uninsured for a specific length of time in order to become eligible.; This dissertation examines the impact these expansions have had on reducing the number of uninsured children in the United States. A probit model is used to estimate the change in insurance status, given the changes in eligibility limits for Medicaid and state programs, based on March 1997–2001 Current Population Survey data. It is estimated that the Title XXI expansions resulted in a 5.9% decrease in the number of uninsured children, based on the simulations performed on the 2000 sample. For states using only Medicaid expansions, the estimated decrease is 8.2%, compared to 5.0% in states using only state program expansions and 7.0% in states using combination expansions.; Comparing the effects of the Title XXI expansions across different poverty level groups, there was not a significant effect for children with family income above 250% of the federal poverty level. States using only Medicaid expansions had the largest impact on uninsurance rates for children below the federal poverty level. For states using only state program expansions or combination expansions, the largest impact on uninsurance rates is observed for children with family income of 100–150% of the federal poverty level.; Average partial effects are also estimated to provide a more direct comparison of the effect of an average-sized expansion through either Medicaid or through a state program. Overall, it is estimated that an average sized Medicaid expansion would result in a 1.21 percentage-point reduction in the number of uninsured children, compared to a 0.65 percentage-point reduction through an equivalent state program expansion.; Based on specification tests, there is some statistical evidence that Medicaid expansions have a stronger impact on reducing the likelihood of being uninsured, compared to state program expansions. However, the simulated changes in insurance status and average partial effects of the expansions do not show any significant differences resulting from Medicaid expansions, compared to state program expansions.