Continuous Medicaid Eligibility During COVID-19 and Children’s Health, Access to Care, Development, and Academic Outcomes

• In Event: Medicaid Policy Levers in Maternal and Child Health: Enrollment, Services, and Access

Abstract

Introduction/Background: Children’s Medicaid enrollment increased during national continuous eligibility under the March 2020 Families First Coronavirus Response Act (FFCRA), particularly for Hispanic children. Medicaid can improve children’s health, development, and education, and may reduce racial and ethnic inequities. 

Purpose/Research Question: This study estimates the association between implementing continuous Medicaid eligibility under the FFCRA and children’s health, access to care, development, and academic outcomes overall and by race and ethnicity.  

Methods: In this analysis of National Survey of Children’s Health (NSCH) data, we used a quasi-experimental difference-in-difference model to compare outcomes among children in 26 states newly implementing continuous Medicaid eligibility for children to children in 24 states with previous continuous eligibility policies before (2017-2019) and during (2020-2022) the FFCRA. Our sample included all children aged 0-17 with incomes at or below 200% of the federal poverty level. Study outcomes included caregiver-reported developmental delays, behavioral problems, general health, difficulties receiving referrals, insurance that allows access to needed providers, confidence that the child is ready for school, and missed school days due to illness or injury. We estimated models for children overall and separately by children’s caregiver-reported race and ethnicity for non-Hispanic Black, Hispanic, and non-Hispanic White children. All models included state and year fixed effects, with covariates for child (age, gender, race and ethnicity), parent (parental educational attainment), and household (nativity, language, number of children) characteristics in adjusted models. We included an indicator for state-level COVID-19 stay-at-home orders to account for variation in state-level policy environments that could affect both Medicaid coverage and children’s academic, health, and developmental outcomes.  

Results/Findings: The sample included 46,454 children (mean age: 8.5 years old in newly implementing states, 47% female, 20.4% non-Hispanic Black, 36.1% Hispanic, and 34.6% non-Hispanic White). In adjusted difference-in-difference models, newly implementing continuous eligibility under the FFCRA was associated with a 2.6 percentage point (95% CI: 0.7, 4.6) increase in children having insurance that allowed them to access needed providers overall. Among Hispanic children, newly implementing continuous Medicaid eligibility was also associated with improvements in general health by 2.3 percentage points (95% CI: 0.9, 3.7) and decreases in referral difficulties by 2.3 percentage points (95% CI: -4.3, -0.2). We found no evidence of an association with changes in children’s other health, development, or academic outcomes overall or by race and ethnicity.

Conclusions/Implications: Implementing continuous Medicaid eligibility under the FFCRA was associated with increases in insurance that allowed children to access providers and additional improvements in health and care access for Hispanic children, with no changes in developmental or academic outcomes for any group. The Consolidated Appropriations Act’s national 12-month continuous eligibility, implemented as states were `unwinding’ the FFCRA, has the potential to yield additional benefits for children as a non-temporary policy and due to implementation outside of the pandemic context.

Author

• Erica Eliason, Rutgers University
  Presenting Author