Rural Health Policy Project

Medicaid’s “Welcome Mat” Effect Means Medicaid Expansion Helps Children Get Health Coverage

New research in the journal Health Affairs this month gives even more evidence for a parental “welcome mat” effect that increases health coverage among children already eligible for Medicaid or the Children’s Health Insurance Program when their parents become eligible as well.  Simply put, moving to “whole family coverage” through a state Medicaid expansion or other provisions of the Affordable Care Act results in more awareness and enrollment of children. This is one of the often overlooked benefits of a state choosing to expand Medicaid to adults – many children get coverage as well. The key findings:

  1. New eligibility for parents under the Affordable Care Act meant over 700,000 children gained health coverage nationwide.
  2. This effect was largest when parents got Medicaid coverage in the 32 states (and DC) where Medicaid was expanded.
  3. If the remaining 19 non-expansion states expanded Medicaid, 200,000 additional children would gain health coverage through existing programs.

[See: “Medicaid Expansion For Adults Had Measurable ‘Welcome Mat’ Effects On Their Children,” J Hudson, A Moriya, Health Affairs, September 2017. ]

So, will encouraging research like this mean more states look at Medicaid expansion over the coming biennium?

Right now Maine is the closest (of the 19 holdout states) to expanding Medicaid.  After passing Medicaid expansion five times but facing a string of vetoes from Maine’s Governor, there is a Maine state ballot initiative on expansion up for a vote in November. Opponents and proponents are mobilizing extensively so expect this to be a close vote despite widespread public support for Medicaid expansion in the state.

Other states that could potentially see movement on Medicaid – especially if the Maine ballot initiative passes – include Georgia, North Carolina, Tennessee, Kansas and Idaho. In each of these states there is some level of discussion about addressing the health coverage gap.  Idaho is floating yet another plan that would extend coverage – but only to certain very limited categories of adults. The Kansas governor’s race includes a Republican frontrunner who has been a strong proponent of Medicaid expansion in a primary with two other Republicans who oppose expansion. And discussion over Medicaid waivers continues in Georgia, especially in rural areas. While talk in Tennessee and North Carolina is more muted, any movement in other states could jumpstart discussion there. North Carolina is considering a major Medicaid restructuring that doesn’t currently include expansion and Tennessee has a strong coalition pushing for addressing the coverage gap in the state.

Adam Searing is an Associate Professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.