Poor and Unhealthy: Life Course Transition and Medicaid Coverage in the Later Life

Ching-Yi A. Shieh, National Institutes of Health (NIH)

An indicator of poor financial and health status, elders covered by Medicaid have higher needs for assistance than the general Medicare population. Using 1998-2008 Health and Retirement Study, this paper examines how individuals’ life course transitions, including their childhood and adulthood life events, affect their later-life health and financial wellbeing as measured by Medicaid coverage. Statistical analyses using discrete-time hazard models demonstrate that marriage provides a safety net to older adults. Although childhood adversities are associated with a higher risk of becoming a Medicaid beneficiary at older ages, the sizes of impact attenuate over time. Elders’ own life course transitions also influence their spouses’ Medicaid coverage. While minority status shows strong effects on most of the outcome variables, it provides very limited explanatory power when both elders and spouses are under coverage.