University Park, Pa. --- The majority of women on Medicaid, the federal/state government-funded health insurance program for the poor, receive health benefits for short periods of time before they transition to private insurance or become uninsured, according to researchers.
``In a recent issue of the journal Health Services Research, the researchers found that 54 percent of single women entering Medicaid receive assistance for less than one year, 31 percent receive assistance for less than two years; and only 15 percent receive assistance for as long as five years. The authors suggest that their model would be useful for future research into the effect of limits on how long women receive Medicaid benefits.
"Although welfare reform has focused on long-term participation in public assistance programs, there is a lot of turnover in Medicaid. We found that about 10 percent of the caseload turns over in a four-month period," said Dr. Pamela Farley Short, director of Center for Health Policy Research and professor of health policy and administration at Penn State, and Vicki A. Freedman, Ph.D., RAND.
"Furthermore, most Medicaid spells are relatively short, with only 31 percent lasting more than two years, the new time-limit on Medicaid for non-workers. Thus relatively few Medicaid spells would be cut short by time limits similar to those imposed on cash assistance," they added.
At the same time, policy makers have good reason to worry about long-term Medicaid participation, because long-time participants account for a significant share of the Medicaid caseload, researchers said. Direct estimates from SIPP [Survey of Income and Program Participation] of the duration of Medicaid spells for a cross-section of recipients at a point in time suggest that limiting all Medicaid spells to five years would eliminate a full third of the caseload. A two-year limit would eliminate more than half the caseload. This is because long spells accumulate in the caseload, while short spells replace each other in the caseload.
The researchers note that two out of three women who leave Medicaid become uninsured. Furthermore, former welfare recipients experience frequent changes in their insurance coverage after they leave Medicaid. According to researchers' estimates, a third of the women who leave the program with private insurance will no longer be insured after a year. Nearly 40 percent who are uninsured when they leave Medicaid will have private insurance after a year, while a quarter will return to Medicaid.
Reflecting on these patterns, where former welfare recipients shift frequently in and out of coverage and from plan to plan, Short and Freedman suggested that policy makers develop a stable source of coverage for these women and then shift the cost among the women, their employers and Medicaid as their incomes and employment change.
The two used data from the Survey of Income and Program Participation, an nationally representative survey of American adults, covering the period from May 1990 to August 1992.
Health Services Research is the official journal of the Association for Health Services Research and published by the Health Research and Educational Trust, an affiliate of the American Hospital Association.
EDITORS: Dr. Short is at 814-863-8786 or at pxs46@psu.edu by email.
Journal
Health Services Research