Why Some Nonelderly Adult Medicaid Enrollees Appear Ineligible Based on Their Annual Income

Area of Science:

• Health Economics
• Public Health Policy
• Social Determinants of Health

Background:

• Recent research indicates significant Medicaid enrollment among middle- and higher-income individuals.
• Concerns exist regarding whether the Medicaid program effectively targets its intended low-income beneficiaries.

Purpose of the Study:

• To analyze Medicaid enrollment patterns relative to income thresholds using administrative and survey data.
• To identify specific enrollment pathways utilized by individuals with incomes exceeding typical eligibility limits.

Main Methods:

• Utilized administrative tax data to determine 2017 Medicaid enrollment and income levels.
• Employed survey data for measuring monthly income fluctuations.
• Leveraged administrative data to map Medicaid enrollment pathways.

Main Results:

• Out of 38.8 million nonelderly adults in Medicaid in 2017, 14.4 million (37%) had incomes above their state's typical threshold.
• 3.5 million individuals enrolled through pathways designed for higher-income categories (e.g., pregnant women, medically needy).
• Over 12 million adults experienced at least one month below the income eligibility threshold, with 4 million experiencing this for five or more months.

Conclusions:

• Higher-income pathways explain a quarter of enrollees with annual incomes above typical thresholds.
• Monthly income variability is a significant factor for many low-income adults exceeding annual thresholds.
• Accurate eligibility assessment necessitates integrated data on income, Medicaid enrollment, and family structure.