Cover: Insurance Coverage During Transitions

Insurance Coverage During Transitions

Evidence from Medicaid Automatic Enrollment for Children Receiving Supplemental Security Income

Published in: Health Services Research (2023). doi: 10.1111/1475-6773.14261

Posted on Nov 29, 2023

by Stephanie Rennane, Danielle Sobol, Bradley D. Stein, Andrew W. Dick


To analyze relationships between Medicaid automatic enrollment for child Supplemental Security Income (SSI) recipients and health insurance coverage during transitions.

Data Sources and Study Setting

Medical Expenditure Panel Study, 2000–2020 and National Survey for Children with Special Health Care Needs, 2001–2010.

Study Design

Leveraging variation in SSI-Medicaid automatic enrollment status across regions and over time, we estimate a regression model to quantify associations between automatic enrollment and insurance coverage. We validate our findings in the NS-CSHCN.

Data Collection

Our sample includes children receiving SSI for a disability. We also analyze a subsample of children newly enrolled in SSI.

Principal Findings

Automatic enrollment is associated with a statistically significant increase in insurance coverage. Expanding automatic enrollment to all states is associated with increases in Medicaid enrollment of 3% (CI 0.9%–6.7%) among all SSI children and 7% (CI 1.1%–13.9%) among children newly enrolled in SSI. We find similar decreases in uninsurance. Analysis in the NS-CSHCN replicates these findings.


Medicaid automatic enrollment policies are associated with increased insurance coverage for SSI children, particularly those transitioning into the program. Medicaid policy defaults could play an important role in reducing administrative burdens to improve children's coverage and access to care.

Research conducted by

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