Association for Public Policy Analysis & Management

Panel: Medicaid, Service Use, and Employment

(Health Policy)

Medicaid is a joint state and federal program that, as of January 2018, provided comprehensive insurance coverage to over 38 million low-income adults.  State and federal policymakers are considering new directions for Medicaid, such as:  expanding eligibility in additional states through the Affordable Care Act (ACA), adding work requirements through state waiver programs, and proposing new laws that would make Medicaid a block grant, rather than entitlement program.  This session comprises papers using diverse statistical methods that provide evidence for policymakers that may assist them in understanding impacts of recent and potential innovations in Medicaid eligibility. 

Two papers provide estimates of the on the impacts of the recent changes in Medicaid eligibility.  Salam Abdus will present “The Effects of Medicaid on Access and Adherence to Recommended Preventive Services,” joint research with Steven C. Hill.  Both researchers are from the Agency for Healthcare Research and Quality.  They use changes in eligibility from 2005 through 2015, a nationally representative survey, and statistical methods that account for endogeneity.  Their paper provides causal estimates quantifying how much Medicaid enrollment improves access to care and use of preventive services. 

Changes in Medicaid can affect other programs, including family planning clinics funded with grants from the Title X program.  Michel Boudreaux will present “Medicaid Expansion and Title X Clinic Attendance,” joint research with Liyang Xie and Yoon Sun Choi.  All three researchers are from the University of Maryland School of Public Health.  They study the effects of eligibility expansions under the ACA using administrative data and difference-in-difference methods.  They find evidence suggesting ACA may have improved the financial health of clinics funded with Title X grants. 

Medicaid enrollment can be brief or ongoing, and employment, health, and changes in employment and health are associated with Medicaid enrollment.  To provide new evidence about these relationships, Jessica Vistnes will present “The Dynamics of Medicaid Enrollment, Employment and Health Status,” joint research with Steven C. Hill.  They use 24 months of data from the nationally representative Medical Expenditure Panel Survey, spanning 2014 and 2015, to describe several dimensions poor health among the minority of Medicaid beneficiaries who did not work at all and better health among those who worked part or all 24 months.  They also examine employment events, health and insurance preceding Medicaid enrollment. 

The discussants and chair will provide Medicaid policy expertise and context for the session.  Martha Heberlein (chair) is a Principal Analyst at the Medicaid and CHIP Payment and Access Commission.Stacey McMorrow (discussant) is a Senior Research Associate in the Health Policy Center of the Urban Institute.  Rachel Garfield (discussant) is the Associate Director of the Program on Medicaid and the Uninsured at the Kaiser Family Foundation.