Extended Postpartum Medicaid Eligibility Is Associated With Improved Continuity Of Coverage In The Postpartum Year

On February 20, 1990, in Sullivan v Zebley, the Supreme Court of the United States struck down the Social Security Administration's criteria for determining eligibility of children with disabilities for Supplemental Security Income (SSI). This dramatic decision held that the existing regulations for the program discriminated against children, because children were required to meet a stricter standard than adults who applied for SSI. This decision overturned the current rules and procedures for the determination of access to a major federal benefits program and, in most states, to additional benefits through assured Medicaid eligibility. The Court also mandated that the Social Security Administration make changes that will significantly alter and liberalize access for children. Because many pediatricians may be unaware of the issues and the potential advantages for children in their care, we summarize below some of the pertinent background and implications of this landmark decision. BACKGROUND AND DESCRIPTION The Supplemental Security Income Program of the Social Security Administration, enacted by Congress in 1972, provides an income supplement to lower income disabled Americans, both children and adults. Persons older than 18 years of age who have a health problem that causes major disability and prevents participation in substantial gainful activity may receive cash benefits as part of a social policy effort that began in the Roosevelt era of the 1930s, although specific disability programs did not begin until the 1960s. Children also may receive cash benefits under certain similar conditions. The SSI program was designed primarily as a social benefit program to improve the financial standing of aged, blind, and disabled individuals, but it also brings automatic eligibility for Medicaid for individuals who qualify for SSI in 31 states and the District of Columbia.

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Physician Reimbursement Under Medicaid

PEDIATRICS ◽

10.1542/peds.89.4.778 ◽

1992 ◽

Vol 89 (4) ◽

pp. 778-780

Author(s):

PHILIP R. LEE ◽

PAUL W. NEWACHECK

Keyword(s):

Federal Poverty Level ◽

Physician Payment ◽

Poverty Level ◽

Physician Reimbursement ◽

Medicare Program ◽

Medicaid Eligibility ◽

Low Levels ◽

Poor Children

Physician payment under Medicaid has been a cause of growing concern among physicians because of the low levels of reimbursement in relation to private payors and the Medicare program in many states. This is particularly important to physicians caring for children because of the growing dependence of poor children on Medicaid and the evolution of Medicaid policies since the mid 1980s. Beginning in the mid 1980s Congress began legislating a series of laws that expanded Medicaid eligibility for poor and near poor children. This series of legislation culminated with the Omnibus Budget Reconciliation Acts of 1989 and 1990. These acts required all states to establish minimum Medicaid income eligibility thresholds at 133% of the federal poverty level for children less than 6 years of age and then subsequently to phase-in coverage, 1 year at a time, for all children through 18 years of age with family incomes less than 100% of poverty level.

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Work Requirements and Perceived Deservingness of Medicaid

American Politics Research ◽

10.1177/1532673x20961317 ◽

2020 ◽

Vol 49 (1) ◽

pp. 30-45

Author(s):

Jennifer D. Wu

Keyword(s):

Health Insurance ◽

Current Literature ◽

Important Determinant ◽

State Governments ◽

Federally Funded ◽

Work Requirements ◽

Medicaid Policy ◽

Survey Experiments ◽

Medicaid Eligibility ◽

Primary Driver

Does an individual’s effort to acquire employer-sponsored health insurance through employment affect whether they are deserving of health insurance? Much of the current literature that examines the deservingness of federally-funded health insurance focuses on an individual’s responsibility in becoming ill. However, logic from the welfare literature would suggest the willingness to work for one’s welfare, or reciprocity, is an important determinant of deservingness. The relevance of employment-seeking in Medicaid deservingness comes at a crucial time given recent attempts by state governments to implement work requirements as a part of Medicaid eligibility. Using a series of survey experiments, I compare the importance of responsibility versus reciprocity and find that responsibility, what one does to become ill, is the primary driver of judgments of deservingness. What one does to earn their Medicaid by working plays a negligible role in driving attitudes. These findings have implications for how we understand the determinants of support for Medicaid policy.

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