Association for Public Policy Analysis & Management

Background. This paper focuses on the older Mexican-origin populations of California and Texas, who spend a large portion of life past 65 with serious and often debilitating health problems. Given their low incomes and levels of wealth, reductions in Medicaid eligibility or extent of coverage could seriously affect this population. Older Hispanics are less likely than non-Hispanic white elders to have Medigap coverage and are highly dependent on Medicaid to pay for what Medicare does not. Methods. We investigate how state policies affect self-reported Medicaid use and changes in self-reported Medicaid receipt among older community dwelling Mexican-origin individuals in California and Texas using data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE). Results. At baseline, 31% of Californians reported receiving Medicaid compared to 41% of Texans. Sensitivity analysis reveals 7% of Medicaid recipients did not report receiving Medicare, suggesting that they are confusing Medicaid for Medicare. The remaining 93% are “dual-eligible.” California respondents were almost twice as likely as Texans to gain coverage at the first follow up. Despite high baseline levels of coverage, Texans were more likely to gain coverage at the 18 year follow up. For both states, being unmarried, having poor health and disability were associated with increased likelihood of coverage. Discussion. Our findings suggest that ensuring adequate medical care to older citizens while containing costs poses clear challenges to California and Texas. Paradoxically, Texas has high Medicaid participation among Mexican-origin elders despite a historically limited social service safety net.