Cost sharing in medicaid and CHIP: How does it affect out-of-pocket spending?

Health Affairs

Volumn 28, Issue 4, 2009, Pages

  Selden, Thomas M ^a   Kenney, Genevieve M ^e   Pantell, Matthew S ^b,c   Ruhter, Joel ^d  

^a AGENCY FOR HEALTHCARE RESEARCH AND QUALITY   (United States)

^b UNIVERSITY OF CALIFORNIA   (United States)

^c UNIVERSITY OF CALIFORNIA   (United States)

^d URBAN INSTITUTE   (United States)

^e NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HEALTH CARE COST; HEALTH CARE POLICY; HEALTH INSURANCE; HEALTH PROGRAM; LOWEST INCOME GROUP; MEDICAID;

CHILD; CHILD HEALTH SERVICES; COST OF ILLNESS; COST SHARING; FINANCING, PERSONAL; HEALTH SERVICES ACCESSIBILITY; HUMANS; INSURANCE, HEALTH; MEDICAID; POVERTY; UNITED STATES;

EID: 67651229055     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.28.4.w607     Document Type: Article

References (38)

1. S. Artiga and C. Mann, "New Directions for Medicaid Section 1115 Waivers: Policy Implications of Recent Waiver Activity," Policy Brief, March 2005, http://www.kff.org/medicaid/loader.cfm?url=/commonspot/ security/getfile.cfm&PageID=52128 (accessed 6 March 2008);
2. and Government Accountability Office, Medicaid and SCHIP: States' Premium and Cost Sharing Requirements for Beneficiaries, Pub. no. GAO-04-491, March 2004), http://www.gao.gov/new.items/d04491.pdf (accessed 6 March 2008).
3. U.S. Department of Health and Human Services, "HHS Approves Medicaid Waiver to Create New Indiana Health Plan for Uninsured Hoosiers," Press Release, 14 December 2007, http://www.hhs.gov/news/press/2007pres/12/20071214a. html (accessed 26 May 2009);
4. and Families USA, "South Carolina Healthy Connections Proposal," January 2006, http://www.familiesusa.org/assets/pdfs/state- medicaid-waivers/South-Carolina-waiver.pdf (accessed 6 March 2008).
5. National Governors Association, "Medicaid Reform: A Preliminary Report," June 2005, http://www.nga.org/Files/pdf/0506medicaid.pdf (accessed 6 March 2008);
6. and NGA, "Short-Run Medicaid Reform," (August 2005, http://www.nga.org/Files/pdf/0508MEDICAIDREFORM.PDF (accessed 6 March 2008).
7. S. Artiga and M. O'Malley, "Increasing Premiums and Cost Sharing in Medicaid and SCHIP: Recent State Experiences," Issue Paper, May 2005, http://www.kff.org/medicaid/upload/Increasing-Premiums-and-Cost-Sharing-in- Medicaid-and-SCHIP-Recent-State-Experiences-Issue-Paper.pdf (accessed 6 March 2008);
8. L. Ku, "Charging the Poor More for Health Care: Cost-Sharing in Medicaid," May 2003, http://www.cbpp.org/5-7-03health.pdf (accessed 6 March 2008);
9. and J. Guyer and C. Mann, "Cost Sharing in Medicaid: Issues Raised by the National Governors Association's Preliminary Recommendations," 2005, http://ccf.georgetown.edu/index/cms-filesystem-action?file=ccf publications/federal medicaid policy/costsharing nga.pdf (accessed 13 May 2009).
10. E.J. Herz, "Medicaid Cost-Sharing under the Deficit Reduction Act of 2005 (DRA)," 25 January 2007, http://assets.opencrs.com/rpts/RS22578- 20070125.pdf (accessed 13 May 2009).
11. Ibid.
12. Social Security Administration, "Coverage Requirements for Children's Health Insurance, Title 21 of Social Security Act," http://www.ssa.gov/OP-Home/ssact/title21/2103.htm (accessed 13 May 2009).
13. Centers for Medicare and Medicaid Services, Letter to State Health Officials, 17 August 2007, http://www.cms.hhs.gov/smdl/downloads/SHO081707.pdf (accessed 13 May 2009);
14. Tricia Brooks, NH Healthy Kids Corporation, "Uninsured Children: Missed Opportunities for Moving Forward," Testimony before the House Energy and Commerce Subcommittee on Health, 29 January 2008, http://energycommerce. house.gov/images/stories/Documents/Hearings/PDF/110-he-hrg.012908. Brooks-testimony.pdf (accessed 13 May 2009);
15. and A. Wolke, "SCHIP Steers through Turbulent Waters" State Health Notes 29, no. 509 (2008), http://www.ncsl.org/programs/health/shn/ 2008/sn509a.htm (accessed 6 March 2008).
16. J.W. Cohen et al., "The Medical Expenditure Panel Survey: A National Health Information Resource," Inquiry 33, no. 4 (1996/97): 373-389;
17. and S.B. Cohen, Sample Design of the 1996 Medical Expenditure Panel Survey Household Component, MEPS Methodology Report no. 2, Pub. no. 97-0027 (Rockville, Md.: Agency for Healthcare Policy and Research, 1997).
18. Additional technical details and estimates are available in an online Technical Appendix, available at http://content.healthaffairs.org/cgi/content/ full/hlthaff.28.4.w607/DC2.
19. MEPS burden estimates for the broader population can be found in J.S. Banthin, P. Cunningham, and D.M. Bernard, "Financial Burden of Health Care, 2001-2004," Health Affairs 27, no. 1 (2008): 188-195;
20. as well as the references cited therein. For spending burden in low-income families with children, see J.S. Banthin and T.M. Selden, "The ABCs of Children's Health Care: How the Medicaid Expansions Affected Access, Burdens, and Coverage between 1987 and 1996," Inquiry 40, no. 2 (2003): 133-145.
21. T.M. Selden, "The Effect of Tax Subsidies on High Health Care Expenditure Burdens in the United States," International Journal of Health Care Finance and Economics 8, no. 3 (2008): 209-223;
22. and J.S. Banthin and T.M. Selden, "Income Measurement in the Medical Expenditure Panel Survey," AHRQ Working Paper no. 06005, July 2006, http://www.meps.ahrq.gov/mepsweb/data-files/publications/workingpapers/wp- 06005.pdf (accessed 13 May 2009).
23. From economic theory (Roy's Identity), evaluating the effect of price changes at observed consumption levels yields valid measures of changes in well-being when such changes are small but may overstate welfare losses from larger cost sharing changes by ignoring behavioral responses. See, for instance, T.M. Selden and M.J. Wasylenko, "Measuring the Distributional Effects of Public Education in Peru," in Public Spending and the Poor: Theory and Evidence, ed. D. van de Walle and K. Nead (Baltimore and London: Johns Hopkins University Press, 1995), 154-186.
24. L.J. Conwell and J.W. Cohen, "Characteristics of Persons with High Medical Expenditures in the U.S. Civilian Noninstitutionalized Population, 2002," Statistical Brief no. 73,March 2005, http://www.meps.ahrq.gov/ mepsweb/data-files/publications/st73/stat73.pdf (accessed 2 August 2008).
25. G. Kenney, J. Ruhter, and T.M. Selden, "The Concentration of Spending among Medicaid/SCHIP Children: Implications for Program Design" (Unpublished paper, Urban Institute, 2009).
26. See the online Technical Appendix, as in Note 10.
27. Ibid.
28. Ibid.
29. Ibid.
30. Guyer and Mann, "Cost Sharing."
31. T.M. Selden, "The Within-Year Concentration of Medical Utilization: Implications for Family Out-of-Pocket Expenditure Burdens," Health Services Research (forthcoming).
32. Ibid.
33. See the online Technical Appendix, as in Note 10.
34. C.D. Bethell et al., "Identifying Children with Special Health Care Needs: Development and Evaluation of a Short Screening Instrument," Ambulatory Pediatrics 2, no. 1 (2002): 38-48.
35. See also AHRQ, MEPS HC-089: 2004 Full Year Consolidated Data File, October 2006, http://www.meps.ahrq.gov/mepsweb/data-stats/ download-data/pufs/ h89/h89doc.pdf (accessed 13 May 2009).
36. See the online Technical Appendix, as in Note 10.
37. G. Kenney et al., "Assessing Potential Enrollment and Budgetary Effects of SCHIP Premiums: Findings from Arizona and Kentucky," Health Services Research 42, no. 6, Part 2 (2007): 2354-2372.
38. Ibid.