This week, I am reading studies about the links between health coverage for parents and children. We are closely following new guidance from CMS on a Medicaid work requirement. Yesterday, Joan Alker explained how a work requirement will lead to coverage losses for parents and harm children. Indeed, the evidence is strong that Medicaid coverage for parents leads to coverage increases and improved health outcomes for children.

Health Affairs’ Medicaid Expansion For Adults Had Measurable ‘Welcome Mat’ Effects On Their Children

The study used data from the 2013-15 American Community Survey to estimate the early welcome mat effects of the ACA’s Medicaid expansion.

What it finds

• The authors estimate that 710,000 children gained public coverage when their parents enrolled in Medicaid between 2013 and 2015. If the remaining 19 non-expansion states expanded Medicaid, 200,000 additional children would gain health coverage through existing programs.
• The effect was largest among children whose parents gained Medicaid eligibility through the expansion. For these children, coverage increased (5.7 percentage points) more than double the increase observed for children whose parents were not eligible for Medicaid (2.7 percentage points).

Why it matters

• Children with parents eligible for Medicaid before and after the ACA had significantly higher coverage rates than children with parents who were not eligible for Medicaid. However, the welcome mat effect only occurred in expansion states for these children.
• The largest percentage gain in coverage was for children with parents who were newly eligible for Medicaid. Check out the chart below from the report.

Pediatrics’ Spillover Effects of Adult Medicaid Expansions on Children’s Use of Preventive Services

Researchers used 2001-2013 MEPS data to examine the relationship between changes in adult Medicaid eligibility and the likelihood that children received annual well-child visits. They looked at families with household incomes below 200% FPL.

What it finds

• Parents enrolled in Medicaid have children who are 29 percentage points more likely to receive a well-child visit.
• The relationship is strongest for families with household incomes between 100% and 200% FPL. In these families, parents enrolled in Medicaid have children who are 45 percentage points more likely to receive a well-child visit.

Why it matters

• The authors raise several explanations regarding why children may benefit from having their parents enrolled in Medicaid. Obtaining health insurance likely improves parents’ ability to navigate the health care system. Insurance also improves families’ finances, which may free up resources for children’s health care.
• The study analyzes data before the implementation of the Affordable Care Act. The findings suggest that the Medicaid expansion in the ACA, which led to coverage gains for parents, may help increase preventive health care for children.

The Urban Institute’s QuickTake: Health Insurance Coverage for Children and Parents: Changes between 2013 and 2017

The brief analyzes data from the Health Reform Monitoring Survey from 2013 through 2017 to examine changes in insurance coverage for children under 18 years old and their parents.

What it finds

• Parents and children are more likely to have health coverage now than they were before the ACA.
• Between June/September 2013 and March 2017, the rate of coverage increased 6.2 percentage points for parents (from 83.2 percent to 89.3 percent) and 1.9 percentage points for children (from 94.8 percent to 96.7 percent).  

Why it matters

• In March 2017, the rate of uninsured children with parents who were uninsured was 21.6 percent compared to only .9 percent for children of insured parents.
• The data show that if parents are insured, their children are almost guaranteed to be insured.  

The Urban Institute’s Health Insurance Coverage among Children Ages 3 and Younger and Their Parents: National and State Estimates

The report uses data from the 2015 ACS to examine the health coverage of young children and their parents.

What it finds

• In 2015, almost half of all young children (under 4 years old) relied on Medicaid for their health coverage, and one-fifth of their parents did, too.
• Comparatively, about 42 percent of children ages 4 to 18 and about 17 percent of their parents received coverage through Medicaid in 2015.

Why it matters

• Young children live in households where they are less likely to have two full-time workers and more likely to have a parent not working. They are also more likely to live in poverty. The lack of affordable childcare is an important factor pushing families with young children into poverty and keeping their parents from working.
• Medicaid is particularly important for parents with young children. They are more likely to receive their health coverage and the coverage of their children through Medicaid than older children.