The Effect of Parental Medicaid Expansions on Children's Health Insurance Coverage

Abstract

Research on public health insurance expansions has typically focused on those targeted by the expansions; we estimate the spillover effects of parental Medicaid expansions on the insurance coverage of their children. Expanding parental Medicaid eligibility may increase participation by already‐eligible, uninsured children by increasing the value of Medicaid enrollment for the entire family. However, parental expansions may also generate crowd out from private coverage. Using the Survey of Income and Program Participation during a period of major parental Medicaid expansions, we find substantial effects of the expansions on the Medicaid participation of children, with evidence of crowd out among some subsamples. (JEL H51, I13, I38)

Adult Medicaid benefit generosity and receipt of recommended health services among low-income children: The spillover effects of Medicaid adult dental coverage expansions

“…More closely related to the present work are studies examining how extending public health insurance eligibility to one family member affects health-care related decisions for other members of the family. Past research has shown that increases in health insurance coverage among parents are associated with an increased likelihood of coverage among already eligible children (Hamersma et al 2018;Hudson & Moriya, 2017;Sommers et al 2016;Devoe et al 2015;Devoe et al 2008;Sommers 2006;Aizer & Grogger 2003;. Several studies using state-level variation in Medicaid eligibility rules for parents to examine this connection find evidence of spillover effects among children (Hamersma et al 2018;Devoe et al 2015;Sommers 2006;Aizer & Grogger 2003).…”

“…Past research has shown that increases in health insurance coverage among parents are associated with an increased likelihood of coverage among already eligible children (Hamersma et al 2018;Hudson & Moriya, 2017;Sommers et al 2016;Devoe et al 2015;Devoe et al 2008;Sommers 2006;Aizer & Grogger 2003;. Several studies using state-level variation in Medicaid eligibility rules for parents to examine this connection find evidence of spillover effects among children (Hamersma et al 2018;Devoe et al 2015;Sommers 2006;Aizer & Grogger 2003). One national study (Hudson & Moriya 2017) and one study of California (Sommers et al 2016) assess the 'welcome mat' effects of the Affordable Care Act's Medicaid expansion to low-income adults and find a substantial increase in child enrollment in public health insurance coverage.…”

Welcome Mats and On‐Ramps for Older Adults: The Impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid

“…Our work adds to the prior literature on both Medicaid participation by older adults and welcome mat effects from Medicaid expansions. The welcome mat literature finds that state Medicaid expansions in the 1990s and 2000s increased Medicaid enrollment by already‐eligible children (Aizer & Grogger, 2003; Dubay & Kenney, 2003; Hamersma, Kim, & Timpe, 2019; Kenney, Long, & Luque, 2010) and reports similar increases in children's Medicaid coverage following the ACA's Medicaid expansions (Hudson & Moriya, 2017; Sommers et al., 2016). Prior studies also document welcome mat effects for working‐age adults in response to Massachusetts’ 2006 reforms (Sonier, Boudreaux, & Blewitt, 2013), the early ACA expansions that took place in 2010 in some states (Sommers et al., 2016; Sommers, Kenney, & Epstein, 2014), and the 2014 ACA Medicaid expansions (Frean, Gruber, & Sommers, 2017).…”

The Affordable Care Act's Effects on Patients, Providers, and the Economy: What We've Learned So Far

“…A federal government report pegged the enrollment increase at 14.5 million people by the beginning of 2016 (Uberoi et al., ). One somewhat unexpected finding is that nearly half of the increase in Medicaid enrollment occurred among those who were already eligible for the program in both expansion and non‐expansion states, the so called “woodwork effect,” (Frean, Gruber, & Sommers, ), which also included increased take‐up among nearly one million children (Hamersma, Kim, & Timpe, ; Kenney et al., ; Ugwi, Lyu, & Wehby, ). Several studies have also demonstrated narrowing of racial/ethnic disparities in insurance coverage after implementation of the ACA, though substantial disparities remain (Buchmueller et al., ; Courtemanche, Marton, Ukert, Yelowitz, Zapata, & Fazlul, ).…”