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Targeting in Medicaid: The costs and enrollment effects of Medicaid's citizenship documentation requirement

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  • Sommers, Benjamin D.

Abstract

The Deficit Reduction Act of 2005 imposed a federal requirement that all individuals provide citizenship documentation when applying for or renewing Medicaid coverage. This represented a change in policy for 46 states. Using differences-in-differences to analyze data from the Current Population Survey (2004-2008), this paper shows that the policy reduced Medicaid enrollment among non-citizens, as intended, and did not significantly affect citizens. One-in-four adult non-citizens in Medicaid (390,000 total) and one-in-eight child non-citizens (81,000) were screened out by the policy annually. Child non-citizens were more likely to become uninsured afterwards, while adult non-citizens appeared to shift from Medicaid to other coverage. Overall, the citizenship documentation requirement reduced Medicaid participation among non-citizens in an appropriately targeted way. Nonetheless, a cost-benefit analysis indicates that the policy was a net loss to society of $600Â million, through increased state administrative spending and compliance costs imposed on U.S. citizens applying for Medicaid.

Suggested Citation

  • Sommers, Benjamin D., 2010. "Targeting in Medicaid: The costs and enrollment effects of Medicaid's citizenship documentation requirement," Journal of Public Economics, Elsevier, vol. 94(1-2), pages 174-182, February.
  • Handle: RePEc:eee:pubeco:v:94:y:2010:i:1-2:p:174-182
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    References listed on IDEAS

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    Cited by:

    1. James Marton & Angela Snyder & Mei Zhou, 2016. "Enhanced Citizenship Verification And Children'S Medicaid Coverage," Economic Inquiry, Western Economic Association International, vol. 54(3), pages 1670-1683, July.
    2. González-Flores, Mario & Heracleous, Maria & Winters, Paul, 2012. "Leaving the Safety Net: An Analysis of Dropouts in an Urban Conditional Cash Transfer Program," World Development, Elsevier, vol. 40(12), pages 2505-2521.
    3. Lilliard E. Richardson & Tansel Yilmazer, 2013. "Understanding the Impact of Health Reform on the States: Expansion of Coverage through Medicaid and Exchanges," Journal of Consumer Affairs, Wiley Blackwell, vol. 47(2), pages 191-218, July.
    4. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2016. "Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States," NBER Working Papers 22182, National Bureau of Economic Research, Inc.
    5. Bronchetti, Erin Todd, 2014. "Public insurance expansions and the health of immigrant and native children," Journal of Public Economics, Elsevier, vol. 120(C), pages 205-219.

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