Medicaid plays an important role in covering health care services for almost half of all children and youth with special health care needs (CYSHCN). When CYSHCN age out of children’s Medicaid and transition to adult Medicaid, they must navigate many changes to their coverage, benefits, and care, and may experience challenges that can lead to gaps and loss of coverage. There are few reported data on the transition-age CYSHCN population or their transitions to adult Medicaid coverage. To address the data gap, MACPAC used 2017–2019 enrollment data from the Transformed Medicaid Statistical Information System to examine this transition-age population.
In this brief, we present the findings from our analysis of CYSHCN and their transitions to adult Medicaid. The brief begins by providing an overview of the methods used to conduct this analysis. Then, it describes the Medicaid-covered transition-age population and their transitions to adult coverage, which includes those who remain continuously covered and those who disenroll and churn. It also describes state policies related to transitions to adult Medicaid coverage and how transition outcomes may differ between individuals enrolled in states with varying Supplemental Security Income eligibility determination policies and states with and without the optional adult expansion pathway. Finally, the brief includes a discussion of the findings and study limitations.
Our findings indicate that 17.6 percent of transition-age CYSHCN enrolled in disability-related eligibility pathways disenrolled from Medicaid or experienced a gap in Medicaid coverage during the year leading up to aging out of child Medicaid. Of those who disenrolled, 33.9 percent re-enrolled within 12 months (i.e., they churned on and off coverage), and the remainder were still disenrolled after 12 months. We also found that the majority of beneficiaries enrolled in the same eligibility pathway or a modified adjusted gross income eligibility pathway when they transitioned to adult Medicaid. In addition, the percentage of beneficiaries across all pathways who remained enrolled during the transition or churned was greater in states that adopted Medicaid expansion compared to those enrolled in states that did not.