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Session Title: A Mixed-Methods Approach to Understanding the Impact of Requiring Citizenship Documentation for Medicaid Enrollment
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Panel Session 386 to be held in Monterey on Thursday, Nov 3, 1:35 PM to 2:20 PM
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Sponsored by the Mixed Methods Evaluation TIG
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| Chair(s): |
| Robert Phillips, The California Endowment, rphillips@calendow.org
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| Abstract:
The federal Deficit Reduction Act of 2005 (DRA) requires citizens applying for or renewing Medicaid coverage to provide documentation establishing citizenship and identity. Implementing this policy affected state and county Medicaid administrators who had to modify existing enrollment processes, as well as current and potential beneficiaries who faced an additional application step before obtaining coverage. This session presents findings from a comprehensive mixed-methods evaluation of the impact of DRA implementation in California, a state that aimed to implement the DRA with as much flexibility as possible to avoid the negative consequences for enrollment that some states reported. To assess the impact of DRA implementation on counties and clients, two surveys of county-level administrators and site visits to six counties were conducted. In combination with Medicaid enrollment records, data collected through the surveys enabled a rigorous quantitative estimate of the DRA's impact on enrollment and retention trends for Medicaid beneficiaries.
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The Medicaid Deficit Reduction Act of 2005 (DRA) Citizenship and Identity Documentation Requirements: Findings From a Survey of California Counties
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| Dana Hughes, University of California, San Francisco, dana.hughes@ucsf.edu
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| Vernon Smith, Health Management Associates, vsmith@healthmanagement.com
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| Carolina Davis, Health Management Associates, cdavis@healthmanagement.com
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To evaluate the impact of the DRA requirements on California, two statewide surveys were conducted of all 58 county social service directors in 2008 and 2009. The first survey gathered information during early implementation, while the second survey was conducted after full operationalization. According to respondents, the DRA requirements had little effect on excluding undocumented residents from Medicaid coverage-its primary intended objective-largely because the undocumented did not apply for Medicaid prior to the new requirements. Rather, the new requirements created burdens on citizens and nationals, possibly leading to delayed entry into care, and caused new administrative burdens and greater costs for counties. The survey findings suggest the benefits of identifying policy and procedural changes to the DRA requirement that would ease the burdens on counties and Medicaid clients while still assuring the integrity of the Medi-Cal eligibility process and supporting federal efforts to streamline Medicaid enrollment.
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Impact of the DRA Citizenship and Identity Documentation Requirement on Enrollment and Retention in Medi-Cal
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| Margaret Colby, Mathematica Policy Research, mcolby@mathematica-mpr.com
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| Brittany English, Mathematica Policy Research, benglish@mathematica-mpr.com
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Between June 2007 and September 2008, California's 58 counties began implementing the DRA's citizenship and identity documentation requirement for beneficiaries seeking Medi-Cal enrollment or renewal. Using enrollment data from the Medi-Cal Eligibility Data System from May 2007 through March 2009, we conducted multivariate regression analyses to estimate average county-level monthly changes in retention, full scope enrollment, and restricted scope enrollment. Models included county and month fixed effects and an indicator for DRA implementation. Separate regressions were run for populations subject to and exempt from the DRA (i.e. current Medicare beneficiaries) and for subgroups defined by age and primary household language. Estimates suggest that DRA implementation did not impact Medi-Cal retention or restricted scope enrollments. However, enrollment for full scope beneficiaries subject to the DRA decreased by 3.8 percent (p=0.019), with larger effects for children. This estimate translates into about 60,000 fewer enrollments than expected in the year following DRA implementation.
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