Report Finds Medicaid Expansion Associated with Lower Child Uninsured Rates

Little girl hugging her dad

In This Report:

Key Findings

  • Growing numbers of uninsured children are concentrating in states that have not expanded Medicaid. Between 2016 and 2019, the child uninsured rate in non-expansion states grew at nearly three times the rate of expansion states. Non-expansion states saw their child uninsured rate jump from 6.5 percent to 8.1 percent during the period examined while expansion states saw it increase from 3.5 percent to 4.1 percent (see figure 3 ). Moreover, two non-expansion states, Texas and Florida, were responsible for 41 percent of the coverage losses for children over the three-year period.
  • While Medicaid expansion was designed to help uninsured adults who could not afford private insurance, the policy change also benefits children. When parents gain coverage, they are more likely to access the supports they need to be a healthy and effective parent, more likely to enroll their children in “whole family” health coverage, and more likely to take their children to the doctor. In short, covering parents also means covering children, protecting families from economic strains associated with medical debt, and laying the groundwork for optimal child development.
  • Extending access to Medicaid coverage for adults benefits the whole family by providing continuous access to care and improving reproductive health. Medicaid expansion has been shown to improve preconception and prenatal care, including increased use of folic acid supplements, critical health screenings, and mental health services. Expansion is also associated with lower maternal and infant mortality rates.


Since its passage in 2010, the Affordable Care Act (ACA) has played a critical role in lowering the rate of uninsured children in America. A key part of the ACA’s success in this area was the Act’s expansion of Medicaid to more working-age adults. In 2016, just two years after the majority of states implemented the Affordable Care Act’s Medicaid expansion, the nation’s uninsured rate for children reached a historic low of 4.7 percent. As states extended Medicaid eligibility to adults up to 138 percent of the Federal Poverty Level (FPL), enrolling newly eligible parents created a “welcome mat” enrollment effect for children—many of whom were already eligible for health coverage but not enrolled in a plan. This meant the child uninsured rate declined in tandem with the non-elderly uninsured rate as parents signed themselves and their entire family up for coverage.

Medicaid expansion has not only reduced the number of uninsured children but also led to improved prenatal and maternal health, higher preventative care use for children, and decreased incidence of child neglect in the states that chose to expand. These coverage and health benefits are not uniform across the states. As of January 2021, nearly eleven years after the passage of the ACA and seven years after Medicaid expansion officially took effect in most states, 12 states have yet to accept federal funding to expand Medicaid coverage to parents and other adults. As a consequence, many families in these states do not have access to affordable coverage, a high share of children remain uninsured, and these health benefits for families go unrealized.

Making matters worse, since 2016 the nation has reversed its historic progress in covering children, and the rate of uninsured children rose by a full percentage point to 5.7 percent in 2019. This increase is driven in large part by the states that have still not expanded Medicaid. Today, while the majority of all children live in expansion states, the majority of uninsured children live in non-expansion states. Expanding Medicaid in the 12 remaining states is a crucial step to put our nation back on track for children’s health and move closer to the day when all children in the U.S. have access to the health care they need to succeed.

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