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This article reviews findings from 38 rigorous studies published in the peer-reviewed literature of the impact of the Medicaid/Children's Health Insurance Program (CHIP) expansions on children. There is strong evidence for increases in enrollment in public programs and reductions in uninsurance following eligibility expansions. Medicaid enrollment continued to increase during the CHIP era (a "spillover effect"). Evidence for improved access to and use of services, particularly for dental care, is also very strong. There are fewer studies of health status impacts, and the evidence is mixed. There is a very wide range in the size of effects estimated in the studies reviewed because of the methods used and the populations studied. The review identifies several important research gaps on this topic, particularly the small number of studies of the effects on health status. Both research methods and findings from the child expansions can provide insights for evaluating the coming expansions for adults under the Affordable Care Act.

For women without medical complications who are able to be served in either setting, our findings suggest that midwife-directed prenatal and labor care results in equal or improved maternal and infant outcomes.

This article provides a comprehensive review of the published literature on the impact of expanding Medicaid for pregnant women to higher income groups of women. The major expansions took place between April 1987 and July 1989. These studies show evidence that new groups of pregnant women received health insurance coverage through Medicaid, and that some women received improved prenatal care services. The evidence is much weaker that the expansions led to improved birth outcomes. The fact that other parts of the developed world have experienced sustained declines in infant mortality without expansions of health insurance coverage points to the complexity in the origins of poor birth outcomes. It is possible that the benefits from the Medicaid expansions were merely victories in small battles within a much larger war that remains to be won.

This study examines racial/ethnic disparities in children's mental health and the receipt of mental health services, and whether those disparities differ between urban and rural areas. We find no significant difference between racial/ethnic groups in the prevalence of child mental health problems in either urban or rural areas. However, there are disparities in the use of mental health services. Hispanic children and Black children in urban areas receive less mental health care than their White counterparts, and the disparity persists for Hispanic children in rural areas, even after controlling for other relevant factors. Initiatives to improve access to mental health care for racial/ethnic minorities should recognize these disparities, and address the lack of culturally appropriate services in both urban and rural areas. In addition, outreach should raise awareness among parents, teachers, and other community members concerning the need for mental health services for minority children.