Single women and the dynamics of Medicaid

Objective. To investigate transitions in and out of Medicaid for a cohort o f single adult women of childbearing age in order to address questions that arise as policymakers try to encourage transitions from welfare to work. Data Sources. Longitudinal data from Waves 2 through 8 of the 1990 panel of the Survey of Income and Program Participation, a nationally representativ e survey of American adults covering May 1990-1992. Study Design We estimate a series of discrete-time legit models with durati on dependence to obtain transition probabilities among Medicaid, privately insured, and uninsured spells. Explanatory variables in the models include prior insurance history, income limits on Medicaid by state, and important socioeconomic and demographic characteristics. We use these models to chara cterize insurance spells for a cohort of single women. Principal Findings. Most Medicaid spells are relatively short. Over half en d in a year or less; only one spell out of seven lasts longer than five yea rs. Two-thirds of Medicaid disenrollees become uninsured. Former welfare re cipients are prone to frequent changes in insurance status. In states with more generous income limits for AFDC, women stay on Medicaid longer, but th ey do not move into the program at a faster rate. Conclusions. Imposing time limits on Medicaid eligibility would affect only a small proportion of Medicaid spells but would eliminate a significant pr oportion of the caseload at a point in time. In considering changes in Medi caid that would encourage transitions from welfare to work and would alter the dynamics of Medicaid, policy-makers need to consider how transitions bo th in and out of private insurance and Medicaid would be affected.