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Journal Issue: Special Education for Students with Disabilities Volume 6 Number 1 Spring 1996

REVISITING THE ISSUES: The Effects of Medicaid Expansions on Insurance Coverage of Children
Lisa C. Dubay Genevieve M. Kenney

To What Extent Is Medicaid Covering the ExpansionTarget Population?

Medicaid participation rates (the proportion of eligibles who were enrolled in the program) in 1993 were much higher for the traditionally eligible population (whose eligibility is tied to welfare participation) than for the expansion-eligible population (those eligible based on the higher income-eligibility cutoffs). The Medicaid participation rate among children whose Medicaid eligibility was tied to welfare participation was 90%. In comparison, the proportion of expansion-eligible children without employer-sponsored coverage who enrolled in Medicaid was 69%. The proportion of expansion-eligible children who report coverage by both employer-sponsored insurance and Medicaid in 1993 was 51%.19 Whether the lower participation rates for the expansion population are the result of lack of knowledge about the new eligibility rules, an unwillingness to enroll in Medicaid, or persisting problems with the Medicaid eligibility determination process is unclear.20

More than a quarter of the children who remained uninsured all year were eligible for Medicaid, a proportion that varied considerably by age. Forty-five percent of uninsured children five years old and under were eligible for Medicaid, compared with 30% and 15% of uninsured 6- to 10-year-olds and 11- to 18-year-olds, respectively. The lower Medicaid eligibility rates for uninsured older children are not particularly surprising, given the very low income-cutoff levels for AFDC-based Medicaid eligibility and the exclusion of most older children from the higher income-eligibility provisions over the analysis period.12