How Have Medicaid, CHIP Expansions Improved Educational Outcomes for Kids?

By Keanan Lane

One of the best ways to promote health care access is through health insurance; however, health care access is not the ultimate goal. Ultimately, the hope is for health care to help individuals lead healthy and productive lives.  A NBER Working Paper sheds light on public insurance’s role in promoting both of these goals for children.

Researchers focused on the Medicaid and CHIP expansions during the 1980s and 1990s to form a sample of children that were potentially affected by gaining insurance access.  Researchers used this panel to determine the long-run effect of coverage on education attainment for these children.  The results provide encouraging evidence for advocates of CHIP  and Medicaid.

A 10 percentage point increase in average Medicaid eligibility for kids between 0-17 years of age led to a decrease in the high school dropout rate, increase in college enrollment, and increase in the four-year college attainment rate. The authors point to the particular importance of these gains among the Medicaid/CHIP population, which contain some of the most disadvantaged groups.  Improvements in health care access can be a means for reducing health disparities, narrowing education gaps, and having a more skilled and productive workforce.

10 percentage point increase in average Medicaid eligibility

High School Non-Completion 5% Decrease
College Attendance 1-1.5% Increase
Four-Year College Attainment 3.3% – 3.7% Increase
Percentages are relative to the sample means
S. Cohodes, S. Kleiner, M. Lovenheim, D. Grossman, “The Effect of Child Health Insurance Access on Schooling: Evidence from Public Insurance Expansions,” NBER Working Paper, No. 20178, May 2014


The study also cited health gains, including a decrease in risky sexual activity by 12%, a reduction in BMI by 1.3% (leading to a 4.3% decrease in likelihood of being obese), fewer mental health issues, and a smaller likelihood of eating disorders.  Not only do these measures indicate improved health, but they also highlight situations that potentially jeopardize a child’s school attendance and academic success.

The paper is demonstration that good health provides a foundation for children to succeed.  The authors end on a “back-of-the-envelope” calculation that estimates the pending elimination of CHIP would reduce eligibility by 15.4 percentage points.  This reduction would threaten the progress made on high school and college attainment.  Debates on the future of CHIP and decisions to expand Medicaid should move beyond just health coverage and access; children’s education is also at stake.