NB22-13: Racial Disparities in SSI Enrollment Across Medicaid Managed Care Plans

Research shows that Black Americans are overrepresented in the SSI program compared to white Americans; however, little is known about how long Black vs. white SSI recipients remain in the program or what their experiences with disability are like. Moreover, it is unclear whether access to high-quality health care can facilitate greater independence or transitions back to work for SSI recipients. This is a proposal to follow Black and white SSI recipients in Medicaid claims data over time, and to explore racial disparities in access to care. I will focus on Medicaid SSI recipients who are required to enroll in comprehensive managed care (MMC) plans in 11 states. Aim #1 is to show how MMC plan options differ for Black vs. white SSI recipients. Aim #2 is to show how plan turnover and plan switching differs for Black vs. white SSI recipients. My hypothesis is that Black recipients have more plan options (because they are more likely to live in urban areas, which can support competition among multiple plans), but they are also more likely to be forced to switch plans (because competition increases rates of plan exit), leading to disruptions in care. Disruptions in care may exacerbate their disabilities and worsen their health status. The long-term goal of this research agenda is to quantify differences in the quality-of-care that Black and white SSI recipients receive in their MMC plans. If Black SSI recipients receive sub-standard care from lower-quality MMC plans, then racial disparities in premature aging and death may persist, and recipients may struggle to return to work.