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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

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  • Melissa McInerney
  • Jennifer M. Mellor
  • Lindsay M. Sabik

Abstract

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.

Suggested Citation

  • Melissa McInerney & Jennifer M. Mellor & Lindsay M. Sabik, 2021. "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," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 40(1), pages 12-41, January.
    • Handle: RePEc:wly:jpamgt:v:40:y:2021:i:1:p:12-41
    DOI: 10.1002/pam.22259
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    References listed on IDEAS

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    1. Robert Kaestner & Bowen Garrett & Jiajia Chen & Anuj Gangopadhyaya & Caitlyn Fleming, 2017. "Effects of ACA Medicaid Expansions on Health Insurance Coverage and Labor Supply," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 36(3), pages 608-642, June.
    2. Congressional Budget Office, 2018. "Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2018 to 2028," Reports 53826, Congressional Budget Office.
    3. Frean, Molly & Gruber, Jonathan & Sommers, Benjamin D., 2017. "Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act," Journal of Health Economics, Elsevier, vol. 53(C), pages 72-86.
    4. Melissa McInerney & Matthew S. Rutledge & Sara Ellen King, 2017. "How Much Does Out-of-Pocket Medical Spending Eat Away at Retirement Income?," Working Papers, Center for Retirement Research at Boston College wp2017-13, Center for Retirement Research.
    5. Anna Aizer & Jeffrey Grogger, 2003. "Parental Medicaid Expansions and Health Insurance Coverage," NBER Working Papers 9907, National Bureau of Economic Research, Inc.
    6. Janet Currie, 2004. "The Take Up of Social Benefits," NBER Working Papers 10488, National Bureau of Economic Research, Inc.
    7. Congressional Budget Office, 2016. "Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2016 to 2026," Reports 51385, Congressional Budget Office.
    8. Congressional Budget Office, 2016. "Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2016 to 2026," Reports 51385, Congressional Budget Office.
    9. Hu, Luojia & Kaestner, Robert & Mazumder, Bhashkar & Miller, Sarah & Wong, Ashley, 2018. "The effect of the affordable care act Medicaid expansions on financial wellbeing," Journal of Public Economics, Elsevier, vol. 163(C), pages 99-112.
    10. Remler, D.K. & Glied, S.A., 2003. "What other programs can teach us: Increasing participation in health insurance programs," American Journal of Public Health, American Public Health Association, vol. 93(1), pages 67-74.
    11. Kosali Simon & Aparna Soni & John Cawley, 2017. "The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 36(2), pages 390-417, March.
    12. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004. "How Much Should We Trust Differences-In-Differences Estimates?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 119(1), pages 249-275.
    13. Sarah Hamersma & Matthew Kim & Brenden Timpe, 2019. "The Effect Of Parental Medicaid Expansions On Children'S Health Insurance Coverage," Contemporary Economic Policy, Western Economic Association International, vol. 37(2), pages 297-311, April.
    14. Congressional Budget Office, 2018. "How CBO Defines and Estimates Health Insurance Coverage for People Under Age 65," Reports 53822, Congressional Budget Office.
    15. Saurabh Bhargava & Dayanand Manoli, 2015. "Psychological Frictions and the Incomplete Take-Up of Social Benefits: Evidence from an IRS Field Experiment," American Economic Review, American Economic Association, vol. 105(11), pages 3489-3529, November.
    16. Melissa McInerney & Jennifer M. Mellor & Lindsay M. Sabik, 2017. "The Effects of State Medicaid Expansions for Working-Age Adults on Senior Medicare Beneficiaries," American Economic Journal: Economic Policy, American Economic Association, vol. 9(3), pages 408-438, August.
    17. Norma B. Coe & April Yanyuan Wu, 2014. "What Impact does Old-age Pension Receipt Have on the Use of Public Assistance Programs Among the Elderly?," Research in Labor Economics, in: Safety Nets and Benefit Dependence, volume 39, pages 259-295, Emerald Group Publishing Limited.
    18. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2017. "Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non‐Expansion States," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 36(1), pages 178-210, January.
    19. Norma B. Coe & April Yanyuan Wu, 2014. "What Impact Does Social Security Have on the Use of Public Assistance Programs Among the Elderly," Working Papers, Center for Retirement Research at Boston College wp2014-5, Center for Retirement Research.
    20. Ghosh, Ausmita & Simon, Kosali & Sommers, Benjamin D., 2019. "The Effect of Health Insurance on Prescription Drug Use Among Low-Income Adults:Evidence from Recent Medicaid Expansions," Journal of Health Economics, Elsevier, vol. 63(C), pages 64-80.
    21. Lara Gardner & Donna B. Gilleskie, 2012. "The Effects of State Medicaid Policies on the Dynamic Savings Patterns and Medicaid Enrollment of the Elderly," Journal of Human Resources, University of Wisconsin Press, vol. 47(4), pages 1082-1127.
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    Cited by:

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    2. Colleen Heflin & Jun Li & Dongmei Zuo, 2023. "Changing patterns of SNAP take‐up and participation and the role of out‐of‐pocket medical expenses among older adults," Applied Economic Perspectives and Policy, John Wiley & Sons, vol. 45(1), pages 336-349, March.

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