Who among the Working-age Disabled on Medicaid Transitions into Dual-eligibility?
We use the 1999-2004 National Health Interview Survey (NHIS) to obtain information on demographic characteristics and self-reported health conditions among adults age 25 to 64. This information is linked to Centers for Medicare and Medicaid Services (CMS) data to select the adults who are Medicaid-only recipients due to disability for the twelve months of the survey year. We then calculate the total Medicaid expenditures in the survey year, and determine whether they remain on Medicaid, transition into Medicare or dual-eligibility, no longer receive public insurance, or die within three years of the survey. We also link to Social Security Administration data to determine whether the individual had acquired enough work credits to become eligible for SSDI and whether the individual receives Supplemental Security Income (SSI) at least once in the survey year.
We describe the differences between disabled Medicaid adults who are and are not work-eligible for SSDI using a linear probability model as a function of demographic attributes, self-reported health status, number of limiting chronic conditions, quartile of Medicaid expenditure in the survey year, needing assistance with instrumental/non-instrumental activities of daily living, and state/year fixed-effects. Indicators for having depression, arthritis, back pain, hypertension, diabetes, breathing problems, heart problem, nervous condition, fracture/bone/joint injury, or mental retardation as a chronic limiting condition are included. Among the work-eligible, we then predict the probability of transitioning into dual-eligibility controlling for the same covariates listed above.
Of the 2,551 Medicaid-only disabled adults in our sample, nearly half (46%) are work-eligible for SSDI. The work-eligible for SSDI are older, male, not married, have more education, are not receiving SSI, and are more likely to suffer from back, breathing, and fracture/bone/joint problems than those not eligible. There are no statistically significant differences in total annual Medicaid expenditures between the two groups. Among the work-eligible, 68% remain in Medicaid, while others transition into dual-eligibility (18%), no longer receive public coverage (7%), died (6%), or are on Medicare only (1%) within three years of the survey. We find few predictors of transitioning into dual-eligibility among the work-eligible, with those receiving SSI less likely to transition, while those that are younger and with back pain are more likely to transition. Future analyses will use the longitudinal CMS data to determine whether there are differences in trends in claims and expenditures between those that transition and those that do not.