Evaluation of Demonstrations of National School Lunch Program and School Breakfast Program Direct Certification of Children Receiving Medicaid Benefits: Access Evaluation Report Nutrition Assistance Program Report January 2015 Food and Nutrition Service Office of Policy Support USDA is an Equal Opportunity Provider Food and Nutrition Service, Office of Policy Support January 2015 Evaluation of Demonstrations of National School Lunch Program and School Breakfast Program Direct Certification of Children Receiving Medicaid Benefits: Access Evaluation Report Authors: Lara Hulsey Anne Gordon Joshua Leftin Nicholas Beyler Allen Schirm Claire Smither-Wulsin Will Crumbley Submitted by: Submitted to: Mathematica Policy Research Office of Policy Support P.O. Box 2393 Food and Nutrition Service Princeton, NJ 08543 3101 Park Center Drive Alexandria, VA 22302 Project Director: Allen Schirm Project Officer: Allison Magness This study was conducted under Contract number AG-3198-B-12-0006 with the Food and Nutrition Service, United States Department of Agriculture. This report is available on the Food and Nutrition website: http://www.fns.usda.gov/research- and-analysis Suggested Citation: Hulsey, L., Gordon, A., Leftin, J., et. al (2015). Evaluation of Demonstrations of National School Lunch Program and School Breakfast Program Direct Certification of Children Receiving Medicaid Benefits: Access Evaluation Report. Prepared by Mathematica Policy Research, Contract No. AG-3198-B-12-0006. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, Project Officer: Allison Magness. This page has been left blank for double-sided copying. Access Evaluation Report Mathematica Policy Research CONTENTS EXECUTIVE SUMMARY ................................................................................................. xi I INTRODUCTION .............................................................................................. 1 A. The School Meals Programs and Direct Certification ................................ 1 1. Opportunities for Direct Certification-Medicaid (DC-M)........................ 3 B. The DC-M Demonstration Evaluation ........................................................ 5 1. Demonstration States and Districts ..................................................... 5 2. Objectives of the Access Evaluation ................................................... 6 3. Overview of Report .............................................................................. 6 II METHODS OVERVIEW ................................................................................... 9 A. Sample ....................................................................................................... 9 B. Data Collection ........................................................................................ 11 C. Process for Matching Student Enrollment and Medicaid Records ........... 12 D. Methods for Analyzing the Effects of DC-M ............................................. 13 E. Pooled Estimates and National Extrapolations ........................................ 16 F. Measuring the Precision of Estimates ...................................................... 16 G. Limitations of the Sample and the Analysis Methods ............................... 17 III DC-M SIMULATION RESULTS ..................................................................... 19 A. Simulated Impact of DC-M: Core Analyses .............................................. 19 1. Variation in Simulated Impacts Across Access Evaluation Districts.............................................................................................. 19 B. Comparison of Alternative Matching Procedures ..................................... 25 C. Results Under Alternative Policies ........................................................... 29 1. Changes in DC-M Rules .................................................................... 30 2. Upcoming Policy Changes that Might Affect DC-M ........................... 33 3. Extrapolations of the Effects of DC-M to Other States and Districts.............................................................................................. 37 iii Access Evaluation Report Mathematica Policy Research D. Reasons Some Eligible Children Are Not Certified Under DC-M ............. 37 1. Unmatched Children in Medicaid Files .............................................. 37 2. Children with Indeterminate Income Eligibility ................................... 40 IV CONCLUSIONS AND LIMITATIONS ............................................................. 41 A. Summary of Findings ............................................................................... 41 B. Limitations of the Findings ....................................................................... 42 REFERENCES .............................................................................................................. 43 APPENDIX A: METHODS ............................................................................................ A.1 APPENDIX B: SUPPLEMENTAL TABLES RELATED TO SIMULATIONS OF DC-M AS CURRENTLY AUTHORIZED ......................................... B.1 APPENDIX C: SUPPLEMENTAL TABLES RELATED TO SIMULATIONS OF DC-M UNDER ALTERNATIVE POLICIES ............ C.1 APPENDIX D: SUPPLEMENTAL TABLES ON REASONS FOR MATCH FAILURE AND INDETERMINATE INCOME ............................. D.1 iv Access Evaluation Report Mathematica Policy Research TABLES I.1 Research Questions for Access Evaluation ............................................................. 7 II.1 Sample for Access Evaluation Analysis ................................................................. 11 III.1 Summary of Simulated Impacts of DC-M ............................................................... 20 III.2 Distribution of Access Evaluation Sample Districts, by Key Thresholds Related to the CEP, Actual October 2011 Direct Certification Rates and Simulated Rates Under DC-M ............................................................................... 24 III.3 Summary of Simulated Impacts of DC-M by Alternative Matching Stringency Levels .................................................................................................. 27 III.4 Summary of Simulated Outcomes under DC-M, with Different Geographic Restrictions on Medicaid Files ............................................................................... 27 III.5 Summary of Simulated Outcomes under DC-M, by Timing of Match ..................... 28 III.6 Summary of Simulated Outcomes under DC-M, Including Other Children in the Household ....................................................................................................... 29 III.7 Summary of Simulated Impacts of Using DC-M for Reduced-Price Certification ........................................................................................................... 32 III.8 Summary of Simulated Impacts of DC-M Under Different Rules for Determining Eligibility ............................................................................................ 33 III.9 Summary of Simulated Impacts of DC-M Under Different Rules for Related Programs ............................................................................................................... 35 III.10 Summary of Simulated Impacts of DC-M, Extrapolated to Other States ................ 38 III.11 Match Rates for Medicaid Children Under Each Matching Stringency Level, October 2011......................................................................................................... 39 A.1 Income Eligibility Limits for Medicaid and CHIP, in SY 2011-2012 ........................ A.6 A.2 Data Elements Available in Medicaid and School District Enrollment Files, by State/District ......................................................................................................... A.9 A.3 Matching Criteria and Stringency Levels ............................................................. A.11 B.1a Certification Counts and Percentages Under Current Certification Procedures (without DC-M) for October 2011, by State ........................................................... B.5 B.1b Certification Counts and Percentages With DC-M Simulation Results Added to Current Certification Procedures for October 2011, by State ............................ B.6 B.2 Certification Counts and Percentages Under Current Certification Procedures and DC-M Simulation Pooled Sample, October 2011 ........................................... B.7 B.3 Simulated Impact of DC-M on Access, Pooled Sample, October 2011 ................. B.8 v Access Evaluation Report Mathematica Policy Research B.4a Distribution of Access Evaluation Sample Districts, by Actual October 2011 Certification Rates and Simulated Rates Under DC-M .......................................... B.9 B.4b Distribution of Access Evaluation Sample Districts, by Percentage Point Increase in Certification Rates Under DC-M Simulation ...................................... B.10 B.5 Distribution of Access Evaluation Sample Districts, by State, by Key Thresholds Related to the CEP, Actual October 2011 Direct Certification Rates and Simulated Rates Under DC-M ........................................................... B.11 B.6 Certification Counts and Percentages Under Current Certification Procedures and DC-M Simulation, by Level of Matching Stringency, Pooled Sample of Districts with Data for All Three Matching Stringency Levels, October 2011 ....... B.12 B.7a Certification Counts