State Medicaid and CHIP options and child insurance outcomes: An investigation of 83 state options with state‐level panel data

Abstract

Medicaid and the Children's Health Insurance Program (CHIP) both combine federal mandates to cover certain services and groups with state options in providing that coverage and in covering other services and groups. Using state‐level panel data, we investigated the relationships of 83 state Medicaid and CHIP options with 2 child insurance outcomes from 2008 to 2018 using structural equation modeling, controlling for 10 possible demographic and economic variables, state fixed effects, and a quadratic year count variable. Our results suggest that eliminating asset tests for children's and parents’ coverage, eliminating or reducing waiting periods for children's coverage, providing express and continuous eligibility for children's coverage, and eliminating face‐to‐face interview requirements for children's coverage may have been especially important in reducing child uninsurance rates and increasing the percentage of children covered by means‐tested public insurance.

The relationship between state Medicaid and CHIP options and child health outcomes

“…In our results, having express eligibility was related to a 0.49% decrease in the preterm birth rate, a 0.18% decrease in the low birthweight rate, and a 0.04% decrease in the very low birthweight rate. Both prior studies that considered the relationship between express eligibility and child insurance outcomes found that express eligibility was related to improved child insurance outcomes (Blavin et al, 2014; Reinbold, 2021), so our results are consistent with those studies.…”

“…The prior studies that have considered relationships between state options and child insurance outcomes have not generally identified copayment amounts as being important factors. However, one prior study (Reinbold, 2021) did find that higher copayments for parents' coverage were related to a lower percentage of children covered by means‐tested public insurance.…”

“…However, not requiring documentation for income or other eligibility criteria was related to better outcomes in two cases, but to a worse outcome in one case. All of those state options have been found to be important for improving child insurance outcomes in prior studies (Bansak & Raphael, 2007;Blavin et al, 2014;Kronebusch & Elbel, 2004;Reinbold, 2021;Wolfe & Scrivner, 2005;Yu & Dick, 2009).…”

“…Almost all of the existing research on different state options under Medicaid and CHIP has considered their effect on child insurance outcomes, rather than child health outcomes. That research has generally concluded that certain state options such as eliminating asset tests for children's or parents' coverage, eliminating or reducing waiting periods for children's coverage, providing express and continuous eligibility for children's coverage, and eliminating face-to-face interview requirements for children's coverage have been particularly important in reducing the percentage of uninsured children and increasing the percentage of children covered by means-tested public insurance (Abdus et al, 2014;Bansak & Raphael, 2007;Blavin et al, 2014;Kronebusch & Elbel, 2004;Ku et al, 2013;Reinbold, 2021;Sommers, 2005;Wolfe & Scrivner, 2005;Yu & Dick, 2009). Many of those studies have taken advantage of a particularly valuable source of data on state options: surveys of state Medicaid and CHIP program officials regarding eligibility, enrollment, renewal, and cost-sharing policies that have been conducted by the KFF annually since 2000 (Brooks et al, 2015(Brooks et al, , 2016(Brooks et al, , 2017(Brooks et al, , 2018(Brooks et al, , 2019(Brooks et al, , 2020Cohen Ross & Cox, 2000, 2002, 2003, 2005Cohen Ross et al, 2007, 2008Heberlein et al, 2011Heberlein et al, , 2012Heberlein, Brooks, Alker, et al, 2013;.…”