The Overlap in SNAP and Medicaid/CHIP Eligibility, 2013: Findings from the Work Support Strategies Evaluation

RESEARCH REPORT The Overlap in SNAP and Medicaid/CHIP Eligibility, 2013 Findings from the Work Support Strategies Evaluation Laura Wheaton Victoria Lynch Martha Johnson December 2016 CENTER ON LABOR, HUMAN SERVICES, AND POPULATION ABOUT THE URBAN INSTITUTE The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. This work is licensed under a Creative Commons Attribution-NonCommercialShareAlike 4.0 International License. Cover image by Tim Meko. Contents Acknowledgments iv The Overlap in SNAP and Medicaid/CHIP Eligibility, 2013 1 Why Measure Eligibility? 1 Determining Eligibility 3 Overlap in Eligibility between SNAP and Medicaid/CHIP 6 State Variation in Eligibility 7 Conclusions 12 Appendix A. Methodology 13 Medicaid/CHIP Simulation 13 SNAP Simulation 14 Overlap in Eligibility 16 Appendix B. State-Level Estimates for All People 17 Appendix C. State-Level Estimates for People with Medicaid/CHIP Coverage or No Coverage 23 Notes 27 References 29 About the Authors 31 Statement of Independence 32 Acknowledgments The Ford Foundation has provided generous lead funding for the Work Support Strategies initiative, including its evaluation, by committing $21 million over five years. The Open Society Foundations, Annie E. Casey Foundation, Kresge Foundation, and JPMorgan Chase also gave crucial support. We are grateful to them and to all our funders, who make it possible for Urban to advance its mission. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders. Funders do not determine research findings or the insights and recommendations of Urban experts. Further information on the Urban Institute’s funding principles is available at www.urban.org/support. We would like to thank Joyce Morton and Silke Taylor for programming support, Genevieve Kenney for her advice on methods, and Pamela Loprest, Stacey Dean, Olivia Golden, and Elizabeth Lower-Basch for their reviews of earlier drafts and helpful insights. IV ACKNOWLEDGMENTS The Overlap in SNAP and Medicaid/CHIP Eligibility, 2013 This report examines the overlap in eligibility among children and nonelderly adults for the nation’s largest nutrition assistance program, the Supplemental Nutrition Assistance Program (SNAP), and the nation’s primary medical assistance programs for low-income families, Medicaid and the Children’s Health Insurance Program (CHIP). We show how many children and adults are eligible, nationally and at the state level, for Medicaid/CHIP, SNAP, or both. We find that nearly 60 percent of children and a quarter of nonelderly adults were eligible for at least one of these programs in 2013. This estimate includes children currently covered by private insurance who would not immediately qualify for CHIP because of waiting periods or other provisions designed to target coverage to the uninsured. The overlap in eligibility varies by state and subgroup (children, parents, and nonparent adults), reflecting differences in eligibility rules and poverty rates. Overlap between SNAP and Medicaid among parents is expected to be higher after 2013 because of Medicaid expansion under the Affordable Care Act (ACA). Although overlap between SNAP and Medicaid among nonparents is also likely to increase, this will be offset somewhat by the reinstatement of SNAP time limits for adults in households without children who do not meet work requirements. Why Measure Eligibility? SNAP and Medicaid/CHIP are key programs in the nation’s social safety net. About one in seven Americans received SNAP in 2013, including 20.9 million children and 21.8 million adults under 60. Participating households received an average of $275 per month to purchase food (Gray 2014). In 2013, Medicaid and CHIP provided health insurance coverage to 33.6 million nondisabled children and 12.7 million nondisabled, nonelderly adults (Snyder et al. 2014). SNAP and Medicaid/CHIP both target low-income people and families. Eighty-three percent of households that received SNAP in 2013 were poor, and these households received 92 percent of all SNAP benefits (Gray 2014). Eighty-nine percent of children and 92 percent of adults enrolled in Medicaid/CHIP have incomes less than 200 percent of the federal poverty level (FPL).1 Although SNAP participation is declining as the economy improves, Medicaid participation continues to increase (Kenney et al. 2016).2 Thus, the results presented here provide insight into the overlap in SNAP and Medicaid/CHIP eligibility before many states expanded Medicaid eligibility under the ACA. In previous work, we provid