Insurance coverage during transitions: Evidence from Medicaid automatic enrollment for children receiving supplemental security income

Abstract

Objectives: To analyze relationships between Medicaid automatic enrollment for child Supplemental Security Income (SSI) recipients and health insurance coverage during transitions.

Data sources and study setting: Medical Expenditure Panel Study, 2000-2020 and National Survey for Children with Special Health Care Needs, 2001-2010.

Study design: Leveraging variation in SSI-Medicaid automatic enrollment status across regions and over time, we estimate a regression model to quantify associations between automatic enrollment and insurance coverage. We validate our findings in the NS-CSHCN.

Data collection: Our sample includes children receiving SSI for a disability. We also analyze a subsample of children newly enrolled in SSI.

Principal findings: Automatic enrollment is associated with a statistically significant increase in insurance coverage. Expanding automatic enrollment to all states is associated with increases in Medicaid enrollment of 3% (CI 0.9%-6.7%) among all SSI children and 7% (CI 1.1%-13.9%) among children newly enrolled in SSI. We find similar decreases in uninsurance. Analysis in the NS-CSHCN replicates these findings.

Conclusions: Medicaid automatic enrollment policies are associated with increased insurance coverage for SSI children, particularly those transitioning into the program. Medicaid policy defaults could play an important role in reducing administrative burdens to improve children's coverage and access to care.

Keywords: Medicaid; Supplemental Security Income; automatic enrollment; children with special health care needs; disabled persons; insurance coverage.