Study: States that expanded Medicaid cut SSI rolls
States that expanded Medicaid, including Wisconsin, saw on average a decline in enrollment for another program that provides cash payments and access to Medicaid for older people or those with disabilities, according to a new study released this month.
The study, published in Health Affairs and co-authored by University of Wisconsin population health sciences professor Marguerite Burns, found that states that expanded Medicaid in 2014 to cover childless adults experienced an average net decline of 3 percent in enrollment for the federal Supplemental Security Income program.
Participants in that program are eligible for Medicaid and receive cash assistance. To qualify, they have to be disabled, blind or elderly; have a lower income than the Medicaid threshold; and pass an asset test to qualify for the program. Wisconsin supplements the payments as well.
Historically, there have been few paths for childless adults with low income to receive Medicaid unless they qualified for the SSI program, Burns said. That changed with the Affordable Care Act, which allowed states to use federal funding to expand Medicaid.
While Wisconsin didn’t take that money, it still expanded eligibility for childless adults. Because it did that, researchers considered Wisconsin an expansion state in the study.
Reducing enrollment in the Supplemental Security Income program could generate savings for states and the federal government because they wouldn’t have to provide the cash assistance and could instead just cover the costs of the Medicaid program, according to the study.
While the study didn’t look at employment levels directly, it suggested that expansion could lead to increased employment for those with disabilities. That’s because those participating in Medicaid expansion can increase their earnings and savings beyond “the very stringent limits” required by the supplementary security income program, said Burns.
Expanding Medicaid eligibility for those in poverty can have “positive spillover effects” on other programs, she said.
“It’s really important to think about the effects of Medicaid expansion beyond their immediate effects on the Medicaid program itself,” she said. “The Medicaid program is very large, complex and interacts with a whole variety of other public safety net programs.”
The study did not break down the effects on a state-by-state level, which Burns said could be an avenue for future study. The study also faced some limitations with the Supplemental Security Income program data.
More research is need to “tease out the various factors” related to Medicaid that affect participation in that program, according to the study.
The study included researchers at Indiana University in Bloomington and Texas A&M University.