Trends in Medicaid and CHIP Eligibility Over Time – Section 4: Eligibility Trends by State Health Ranking – 8762

This section analyzes trends in eligibility over time by state health ranking. State health rankings were based on the 2014 America’s Health Rankings report, which included data for all 50 states, but not DC. The rankings are developed based on measures related to four groups of health determinants, including individual behaviors, community and environment, policy, and clinical care, and measures of health outcomes. An overall health score is created for each state based on how they fare on each measure compared to the national average. (See Appendix B for more details.) For this analysis, states were categorized into three groups based on their health ranking scores. A total of 22 states with a negative score were classified as low health ranking states, 15 states with scores between 0 and .39 were grouped as middle health ranking states, and 13 states with scores above .40 were categorized as high health ranking states [exhibit 4.1].

For children, parents, and other adults, states with the lowest health rankings have the lowest median eligibility limits over time, while states with the highest health rankings have the highest median eligibility limits. Gaps between median income eligibility limits for high and low health ranking states are largest for other adults and children. This gap also exists for parents, but it narrowed after implementation of the Medicaid expansion. For pregnant women, middle health ranking states have the highest median eligibility limits. While the high and low health ranking states have lower median eligibility limits compared to the middle health ranking states, the differences in median eligibility limits by health ranking are smaller for pregnant women compared to the other eligibility groups.

Children. Between 2000 and 2015, median eligibility limits for children increased in high and middle ranking states [exhibit 4.2]. Increases were largest and occurred earlier in high health ranking states compared to the middle health ranking states. Median eligibility limits did not change in the low health ranking states except for the conversion to MAGI-based standards as of January 2014.

Pregnant women. Median eligibility limits for pregnant women increased for middle health ranking states between 2003 and 2015 [exhibit 4.3]. For states with high and low health rankings, the change in median eligibility limits reflect the conversion to MAGI-based standards.

Parents. Median eligibility limits for parents increased between 2002 and 2015 across all three groups of states [exhibit 4.4]. States with high health rankings started with higher eligibility limits as of 2002 compared to the other middle and low health ranking states, and remained the highest as of 2015. The middle and low health ranking states had similar median eligibility limits as of 2002, but the middle health ranking states experienced a larger increase in the median eligibility limit than the low health ranking states over the period.

Other adults. The high health ranking states were the only group to show an increase in the median eligibility limit for other adults between 2011 and 2015 [exhibit 4.5]. This increase reflects adoption of the Medicaid expansion in most of the states that have a high health ranking. In contrast, the median eligibility limit for middle and low health ranking states remained at 0% FPL, because more than half of the states in each of these groups did not adopt the Medicaid expansion.

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