Children’s Health Insurance Program Expansions: What Works for Families?

Abstract

We examine the impact of Children’s Health Insurance Program (CHIP) eligibility expansions 1999 to 2012 on child and joint parent/child insurance coverage. We use changes in state CHIP income eligibility levels and data from the Current Population Survey Annual Social and Economic Supplement to create child/parent dyads. We use logistic regression to estimate marginal effects of eligibility expansions on coverage in families with incomes below 300% federal poverty level (FPL) and, in turn, 150% to 300% FPL. The latter is the income range most expansions targeted. We find CHIP expansions increased public coverage among children in families 150% to 300% FPL by 2.5 percentage points (pp). We find increased joint parent/child coverage of 2.3 pp ( P = .055) but only in states where the public eligibility levels for parent and child are within 50 pp. In these states, the CHIP expansion increased the probability that both parent/child are publicly insured (2.5 pp) among insured dyads, but where the eligibility levels are further apart (51-150 pp; >150 pp), CHIP expansions increase the probability of mixed coverage—one public, one private—by 0.9 to 1.5 pp. Overall, families made decisions regarding coverage that put the child first but parents took advantage of joint parent/child coverage when eligibility levels were close. Joint public parent/child coverage can have positive care-seeking effects as well as reduced financial burdens for low-income families.

The Mitigating Toxic Stress Study Design: Approaches to Developmental Evaluation of Pediatric Health Care Innovations addressing Social Determinants of Health and Toxic Stress

“…(33,34). Medicaid demonstration programs are testing different payment and delivery models that include broadening services to health-related needs such as providing community health workers to assist families with housing, food and income (35,36). The recently introduced Social Determinants Accelerator Act of 2019 would convene a federal inter-agency technical advisory council to identify opportunities for state and local governments to coordinate funding and administration of federal programs that may be underutilized or unknown.…”

A Study of Community and Health Clinic Approaches to Addressing Toxic Stress and Promoting Protective Factors among Families with Infants

“…The initial phase evaluation results show challenges in areas such as having an adequate work force to address social needs, lack of standardization, adequate data systems, and closing referral loops between health care and community services (30,31). Medicaid demonstration programs are also testing different payment and delivery models that can include broadening services to health-related needs such as providing community health workers to assist families with housing, food and income (32,33). The recently introduced Social Determinants Accelerator Act of 2019 would convene a federal inter-agency technical advisory council to identify opportunities for state and local governments to coordinate funding and administration of federal programs that may be underutilized or unknown.…”

“…Child health insurance programs have extended well-child and illness care to millions of uninsured families throughout the U.S. (12), making more apparent the many unaddressed physical health and social needs they face. Latinx families in the U.S. have the highest uninsured rates, compared to other racial or ethnic groups, with only 49% reporting insurance coverage in 2017 (13).…”

The Mitigating Toxic Stress Study Design: Approaches to Developmental Evaluation of Pediatric Health Care Innovations addressing Social Determinants of Health and Toxic Stress

“…There is preliminary evidence of similar models in the area of increasing families' access to resources and improving socio-economic circumstances. For example, using the WE CARE model to systematically screen and refer families to services, results of a randomized control trial including 336 mothers in 8 community health centers showed that mothers who received the intervention were more likely to be employed, less likely to be homeless, and to have accessed at least one resource compared with mothers who did not receive the intervention (32) (35,36). The recently introduced Social Determinants Accelerator Act of 2019 would convene a federal inter-agency technical advisory council to identify opportunities for state and local governments to coordinate funding and administration of federal programs that may be underutilized or unknown.…”