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

CONTEXT: Recent studies have highlighted Medicaid enrollment among middle- and higher-income populations and questioned whether the program is reaching those for whom it is intended. METHODS: Medicaid enrollment and income in 2017 are measured using administrative tax data, monthly income is measured using survey data, and Medicaid enrollment pathways are identified in administrative data. FINDINGS: Among 38.8 million nonelderly adults in Medicaid at any point in 2017, 24.4 million had annual income below their state's typical eligibility threshold, and 14.4 million (37%) had income above the threshold. Among those above the threshold, 3.5 million enrolled through a pathway allowing higher income (pregnant women, the "medically needy", and others); we also estimate that over 12 million had at least one month with income below the threshold and roughly 4 million had at least five months with income below the eligibility threshold. CONCLUSION: Pathways allowing higher income account for one-quarter of enrollees with annual incomes above typical thresholds. Among low-income adults, month-to-month variation in income is common and can account for most or all of the remaining enrollees with annual incomes above typical thresholds. A complete accounting of eligibility status would require merged data on income, Medicaid enrollment, and family structure.

Health Insurance For People Younger Than Age 65: Expiration Of Temporary Policies Projected To Reshuffle Coverage, 2023-33.

The Congressional Budget Office estimates that in 2023, 248 million people in the US who are younger than age sixty-five have health insurance coverage (mostly through employment-based plans), and twenty-three million people, or 8.3 percent of that age group, are uninsured-with significant variations in coverage by income and, to a lesser extent, by race and ethnicity. The unprecedented low uninsurance rate is largely attributable to temporary policies that kept beneficiaries enrolled in Medicaid and enhanced the subsidies available through the health insurance Marketplaces during the COVID-19 pandemic. As the continuous eligibility provisions unwind in 2023 and 2024, an estimated 9.3 million people in that age group will transition to other forms of coverage, and 6.2 million will become uninsured. If the enhanced subsidies expire after 2025, 4.9 million fewer people are estimated to enroll in Marketplace coverage, instead enrolling in unsubsidized nongroup or employment-based coverage or becoming uninsured. By 2033 the uninsurance rate is projected to be 10.1 percent, which is still below the 2019 rate of about 12 percent.

Understanding the increasingly popular itemized deduction for medical expenses.

Itemized deduction for medical expenses has existed in one form or another for more than 60 years. One justification for this tax deduction is that it reduces the burden for taxpayers with catastrophic expenses. Currently it shields more out-of-pocket spending on health care from taxes than any other tax provision. Based on a repeated cross section from 1999 to 2005 and a 5-year panel of tax returns, we find that filers aged 65 years or older claim the deduction more often, deduct larger amounts, and do so more persistently than younger taxpayers. Augmenting tax data with information from the MEPS, we find that no more than 41% of all tax units with non-tax preferred medical expenditures exceeding 10% of income claimed the deduction in 2005. Even for those claiming the deduction, the average tax benefit of the deduction offsets less than 10% of medical expenditures.

Medical savings accounts: what story do the data tell?

Fewer than a quarter-million tax units had reported a medical savings account (MSA) by the end of 2001. Nearly one-quarter of those having an MSA reported being previously uninsured. The tax data support the prediction that higher-income taxpayers are more likely than others to be MSA consumers. Surprisingly, the middle-aged had the greatest predicted MSA demand, even after income and marginal tax rate were controlled for. There is mixed evidence as to whether the account was treated as a savings vehicle. For those who continued their accounts, their build-up was generally sufficient to offset a year or two of future medical expenses below the deductible.