Maternal and child patterns of Medicaid retention: a prospective cohort study

Abstract

BackgroundWe sought to determine whether maternal Medicaid retention influences child Medicaid retention because caregivers play a critical role in assuring children’s health access.MethodsWe conducted a longitudinal prospective cohort study of a convenience sample of 604 Medicaid-eligible mother-child dyads followed from the infant’s birth through 24 months of age with parent surveys. Individual enrollment status was abstracted from administrative Medicaid eligibility files. Generalized estimating equations quantified the effect of maternal Medicaid enrollment status on child Medicaid retention, adjusting for relevant covariates. Because varying lengths of gaps may have different effects on child health outcomes, Medicaid enrollment status was further categorized by length of gap: any gap, > 14-days, and > 60-days.ResultsThis cohort consists primarily of African-American (94%), unmarried mothers (88%), with a mean age of 23.2 years. In multivariable analysis, children whose mothers experienced any gaps in coverage had 12.6 times greater odds of experiencing gaps when compared to children whose mothers were continuously enrolled. Use of varying thresholds to define coverage gaps resulted in similar odds ratios (> 14-day gap = 11.8, > 60-day gap = 16.8). Cash assistance receipt and maternal knowledge of differences between Temporary Assistance to Needy Families and Medicaid eligibility criteria demonstrated strong protective effects against child Medicaid disenrollment.ConclusionsMedicaid disenrollment remains a significant policy problem and maternal Medicaid retention patterns show strong effects on child Medicaid retention. Policymakers need to invest in effective outreach strategies, including family-friendly application processes, to reduce enrollment barriers so that all eligible families can take advantage of these coverage opportunities.

Medicaid Disruption Among Transition-Age Youth on the Autism Spectrum

“…Similarly, individuals with two consecutive months enrolled in Medicaid after their first observed disenrollment were classified as re-enrolled. Previous research using Medicaid and other insurance data has also relied on a 2-month requirement for disenrollment and re-enrollment (Ji et al, 2017; Pati et al, 2018; Tao & Patel, 2016; Zhang et al, 2020).…”

Five-Year Outcomes Among Medicaid-Enrolled Children With In Utero Opioid Exposure

“…Children are more likely to stay enrolled in Medicaid if they have low household incomes or poor health status, or if their parents are also enrolled in Medicaid. [29][30][31] In our study population we observed differential loss to follow-up by race, length of maternal Medicaid enrollment, and health status (see appendix exhibit A2). 27 To reduce the bias in our estimates due to this differential loss to follow-up, we constructed inverse-probability-of-censoring weights.…”

Health Insurance Coverage, Clinical Outcomes, and Health-Related Quality of Life Among Youth Born to Women Living With HIV

“…Because HIV disproportionately affects racial, ethnic and sexual minority communities and people living in poverty, barriers to insurance coverage may affect not only YPHIV and YAPHIV, but also youth and young adults perinatally exposed to HIV but uninfected (YPHEU and YAPHEU), also born to women living with HIV (WLHIV). 21,22 Studies have shown increased burden of mental health challenges among both children and adolescents living with perinatally-acquired HIV (PHIV) and those who were perinatally exposed to HIV but uninfected compared with the general US youth population, with some evidence for greater burden among YPHEU. 23,24 Studies have also highlighted that adverse health outcomes may be attributed to sociocontextual factors such as education, access to care, and social support among those perinatally exposed to HIV, but uninfected compared with those unexposed.…”

“…Because HIV disproportionately affects racial, ethnic and sexual minority communities and people living in poverty, barriers to insurance coverage may affect not only YPHIV and YAPHIV, but also youth and young adults perinatally exposed to HIV but uninfected (YPHEU and YAPHEU), also born to women living with HIV (WLHIV). 21,22…”