Date of Award


Document Type

Open Access Dissertation


Health Services and Policy Management


The Norman J. Arnold School of Public Health

First Advisor

Janice C. Probst


Previous investigations show high rates of enrollment discontinuity, or churn, among Medicaid participants. Discontinuity of coverage can limit appropriate use of health care, increase emergency department utilization and in-patient hospitalization, negatively affect self-reported health, increase health care spending, and compound Medicaid administrative costs. Efforts to more fully understand and ultimately reduce enrollment churn thus are vital to Medicaid agencies and beneficiaries. Residential moves are life transitions, often marking other significant life events (e.g., changes in employment or family structure) that can alter eligibility for Medicaid benefits. Few studies have examined residential moves among Medicaid members, or considered residential mobility as a potential predictor of churn. The present investigation describes within-state residential moves in a Medicaid population, and evaluates the multivariable association between within-state residential mobility and Medicaid enrollment discontinuity. Based on a sample of 428,294 full-benefit, non-elderly South Carolina Medicaid recipients, 28% of Medicaid members were found to move between ZIP Code Tabulation Areas during a 4-year observation period (2013-2016). Medicaid member movers were approximately 1.7 times more likely than non-movers to churn in the Medicaid system, considering age category, gender, race/ethnicity, and health status, and controlling for the number of observation years each subject was present in the study (AOR=1.74; 95% CI=1.72-1.76). In light of study results, Medicaid policy implications are identified and directions for future research are proposed.