Implications of the Growth of Defined Contribution Retirement Plans for Safety Net Eligibility: The Case of Dual Eligibility for Medicare and Medicaid.

Small balances from tax-preferred retiremet accounts such as 401(k)s and IRAs can render some older adults ineligible for Medicaid, an important supplement to Medicare for older and disabled Americans who have low income and assets. The purpose of this study is to understand whether older low-income adults have assets in these tax-preferred accounts, hereafter defined contribution (DC) wealth, and whether DC wealth has implications for Medicaid eligibility. Using 2015-19 Medicare Current Beneficiary Survey (MCBS) data, the study finds half of all older adults with low income have either DC wealth or income from defined benefit (DB) pension plans and DC wealth is becoming more prevalent among younger cohorts of older adults, who are more likely to have DC wealth than DB income. Older adults with DC wealth are 5.5 percentage points less likely to be eligible for Medicaid than similar peers with DB income. In an exercise where DC wealth is hypothetically converted to an annuity, this eligibility gap falls by one-third to nearly one half. A possible policy solution would be to exclude DC wealth from the asset test, which would target the least advantaged beneficiaries and mimic the current eligibility criteria of the Supplemental Nutrition Assistance Program (SNAP).