Research & Analysis by Gerald F. Riley
State Medicaid Eligibility and Enrollment Policies and Rates of Medicaid Participation among Disabled Supplemental Security Income Recipients
In addition to providing income-maintenance payments to eligible participants, the Supplemental Security Income (SSI) program provides automatic Medicaid enrollment for applicants upon SSI award in most states. Other states require applicants to file a separate Medicaid application. Some use the SSI eligibility criteria for both programs; others use Medicaid eligibility rules that are more restrictive. The authors use matched monthly longitudinal administrative records to test whether automatic enrollment has a positive effect on Medicaid coverage. Using logistic regression with a combination of repeated cross-section and regression discontinuity approaches, they find positive effects of automatic enrollment on Medicaid coverage relative to other policies. The differences are attributable to a discontinuous increase in Medicaid coverage shortly after the final disability determination decision. The time lag arising from the often-lengthy disability determination process reduces the effectiveness of automatic enrollment, which depends critically on timeliness of the final award decision.
This article analyzes the effect of longitudinal interactions between the Disability Insurance (DI) and Supplemental Security Income (SSI) programs in providing access to Medicare and Medicaid, using a sample of administrative records spanning 84 months. Our study is the first effort to link and analyze record data on participation in all four of these major, and highly interrelated, public benefit programs in the United States. We find that SSI facilitates high levels of Medicaid coverage for SSI awardees overall and provides access to Medicaid for many DI awardees during the 24-month Medicare waiting period. Many people who exit SSI retain their Medicaid coverage, but the gap in coverage between continuing SSI participants and those who leave the program increases over time. After Medicare kicks in, public health insurance coverage is virtually complete among awardees with some DI involvement, including dual Medicaid and Medicare coverage for some.
Longitudinal Patterns of Participation in the Social Security Disability Insurance and Supplemental Security Income Programs for People with Disabilities
We analyze longitudinal interactions in benefit eligibility between the Disability Insurance and Supplemental Security Income programs and the lags arising from processing time in receiving the first payment, based on Social Security administrative records. We find that longitudinal interactions enhancing the bundle of cash benefits available for awardees over a 60-month period is much more common than apparent from cross-sectional data and identify distinct patterns of longitudinal interactions between the two programs. SSI plays an especially important role in providing benefit eligibility during the 5-month DI waiting period. Transition to nonbeneficiary status is more prevalent among SSI awardees because of exits attributable to the SSI means test. We also find that there is substantial variation in the lag in receiving the first disability payment.
Statistical Methods for the Estimation of Costs in the Medicare Waiting Period for Social Security Disabled Worker Beneficiaries
This paper presents the statistical methods used to estimate Medicare costs in the waiting period that were presented in text tables 2–3 of Bye and Riley (1989). The first part describes the development of Medicare utilization equations for each Social Security Disability Insurance (DI) program status group. The second part describes how these equations were used to predict expected costs per month and how the monthly estimates were aggregated to yield estimates of costs in the full 2-year waiting period and in the second year only. Finally, there is a brief discussion of the accuracy of the predictions.