The Effects of State Medicaid Policies on the Dynamic Savings Patterns and Medicaid Enrollment of the Elderly

Gardner, Lara; Gilleskie, Donna B.

doi:10.1353/jhr.2012.0030

Cited by 12 publications

(4 citation statements)

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“…Ungaro and Federman (2009) found that persons in states with liberalized Medicaid eligibility rules (rules that exclude certain income or asset amounts when making eligibility determinations) were more likely to enroll in Medicaid. Pezzin and Kasper (2002) and Gardner and Gilleskie (2012) found that persons in states with more generous coverage for HCBS were more likely to enroll in Medicaid. Examining the effects of state Medicaid expansions in the 2000s, McInerney, Mellor, and Sabik (2017) found some evidence that low‐income older adults were more likely to be enrolled in Medicaid in states with more generous Medicaid eligibility for adults ages 20 to 64 years old.…”

Section: Background and Related Literaturementioning

confidence: 99%

Welcome Mats and On‐Ramps for Older Adults: The Impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid

McInerney¹,

Mellor²,

Sabik³

2020

J Policy Anal Manage

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For many low‐income Medicare beneficiaries, Medicaid provides important supplemental insurance that covers out‐of‐pocket costs and additional benefits. We examine whether Medicaid participation by low‐income adults age 65 and up increased as a result of Medicaid expansions to working‐age adults under the Affordable Care Act (ACA). Previous literature documents so‐called “welcome mat” effects in other populations but has not explicitly studied older persons dually eligible for Medicare and Medicaid. We extend this literature by estimating models of Medicaid participation among persons age 65 and up using American Community Survey data from 2010 to 2017 and state variation in ACA Medicaid expansions. We find that Medicaid expansions to working‐age adults increased Medicaid participation among low‐income older adults by 1.8 percentage points (4.4 percent). We also find evidence of an “on‐ramp” effect; that is, low‐income Medicare beneficiaries residing in expansion states who were young enough to gain coverage under the 2014 ACA Medicaid expansions before aging into Medicare were 4 percentage points (9.5 percent) more likely to have dual Medicaid coverage relative to similar individuals who either turned 65 before the 2014 expansions or resided in non‐expansion states. This on‐ramp effect is an important mechanism behind welcome mat effects among some older adults.

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Section: Background and Related Literaturementioning

confidence: 99%

Welcome Mats and On‐Ramps for Older Adults: The Impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid

McInerney¹,

Mellor²,

Sabik³

2020

J Policy Anal Manage

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“…Fourth, the MCBS data suggest that one type of misclassification error-false negative reports-exhibits year-toyear variation that differs across states among low-income community dwelling older adults. This is notable since many prior studies on the effects of state policies on duals' Medicaid participation use difference-in-difference models that rely on the common trends assumption or the assumption that preperiod patterns in Medicaid participation are similar in states that experience policy interventions and states that do not (Gardner & Gilleskie, 2012;McInerney et al, 2017;Pezzin & Kasper, 2002;Ungaro & Federman, 2009). While many factors could lead this assumption to be violated, one factor could be the presence of differential trends in misclassification across states; our results suggest that factor may be a concern in some populations, at least in our data set and time period (2011)(2012)(2013).…”

Section: Discussionmentioning

confidence: 99%

“…Dual Medicare–Medicaid enrollees represent a costly and vulnerable population. Research studies on duals—including studies on dual Medicaid enrollment and how it is affected by policy changes (Borella et al, 2018; Ettner, 1997; Gardner & Gilleskie, 2012; McInerney et al, 2017; Pezzin & Kasper, 2002; Ungaro & Federman, 2009), studies on the association between dual enrollment and health care utilization (Moon & Shin, 2006; Rahman, Tyler, Thomas, Grabowski, & Mor, 2015), or studies of health, disability, and service use within the dual-eligible population (Reichard & Fox, 2013)—can offer important lessons for public policy and public health. Investigations of these issues based on survey data will benefit from careful attention to the potential for misclassification of Medicaid participation and ways to address the bias arising from it.…”

Section: Discussionmentioning

confidence: 99%

Misclassification of Medicaid Participation by Dual Eligibles: Evidence From the Medicare Current Beneficiary Survey

2019

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Previous studies show that survey-based reports of Medicaid participation are measured with error, but no prior study has examined measurement error in an important segment of the Medicaid population—low-income adults enrolled in Medicare. Using the Medicare Current Beneficiary Survey, we examine whether respondent self-reports of Medicaid enrollment match administrative records and present several key findings. First, among low-income Medicare beneficiaries, the false negative rate is 11.5% when the self-report is interpreted as full Medicaid and 3.7% when the self-report is interpreted as full or partial Medicaid. Second, the likelihood of a false negative report is systematically associated with respondent traits. Third, systematic measurement error results in biased coefficient estimates in models of Medicaid participation defined from self-reports, and the bias is more significant when the researcher interprets self-reports as full Medicaid coverage only. Researchers should use caution when interpreting survey reports as pertaining to full Medicaid coverage only.

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“…Hurst and Ziliak (2006) find no evidence that the relaxation of welfare asset limits in the 1990s increased the savings of younger households. Likewise, Gardner and Gilleskie (2012) examine state-level reforms that increased Medicaid generosity and find no evidence that Medicaid crowds out private savings. In contrast, Greenhalgh-Stanley (2012) shows that estate-recovery programs, which enforce Medicaid asset limits among homeowners, crowd out home equity holdings and reduce homeownership.…”

Section: Means-tested Programs and Savings Crowd-outmentioning

confidence: 99%

Savings after retirement

French¹,

Jones²,

McGee³

2022

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Retired households, especially those with high lifetime income, decumulate their wealth very slowly, and many die leaving large estates. The three leading explanations for the 'retirement savings puzzle" are the desire to insure against uncertain lifespans and medical expenses, the desire to leave bequests to one's heirs, and the desire to remain in one's own home. We discuss the empirical strategies used to differentiate these motivations, most of which go beyond wealth to exploit additional features of the data. The literature suggests that all the motivations are present, but has yet to reach a consensus about their relative importance.

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The Effects of State Medicaid Policies on the Dynamic Savings Patterns and Medicaid Enrollment of the Elderly

Cited by 12 publications

References 0 publications

Welcome Mats and On‐Ramps for Older Adults: The Impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid

Welcome Mats and On‐Ramps for Older Adults: The Impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid

Misclassification of Medicaid Participation by Dual Eligibles: Evidence From the Medicare Current Beneficiary Survey

Savings after retirement

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