Porthole
The System Dynamics of Medicaid Enrollment: A New Approach to Inform Policy (307828)
Lisa A Frazier, Miami University*Marian Frazier, College of Wooster
Keywords: Medicaid, simulation, policy implementation, complex system
In Medicaid, churn (movement on and off the program) and missed take-up among the eligible are problems for both individuals and States. Existing studies of Medicaid treat program enrollment as a proportional sum of individual status, which cannot capture delays, feedback, or other complexities in the Medicaid system. A computational model is necessary to allow emergent, system-level behaviors over time, and to model the interplay between eligibility, administrative features, and enrollment outcomes. System dynamics models reflect such phenomena within a complex system. In this work, we build and calibrate a system dynamics simulation of Medicaid eligibility, application, and enrollment for a virtual population over 10 years. Our simulation replicates observed program-level patterns in Ohio Medicaid, demonstrating persistent churn and missed take-up, despite growth in caseloads over time. We simulate several policy scenarios recommended in the literature to explore possible responses at the program level. This way of modeling Medicaid program enrollment has implications for programmatic decision-making, as well as for data collection and inference in Medicaid coverage research.