research

Executive Summary

Almost half the states offer 12-month continuous eligibility to children in their Medicaid programs to help children in low-income families retain insurance coverage and access to medical care throughout the year. This study analyzes the association of this policy for children in low-income families with a variety of health outcomes, including insurance gaps, access to preventive, general and specialty care, and health status. Using data pooled from the 2016 to 2018 National Surveys of Children’s Health (n = 17,610), we examine outcomes for children under the age of 18 whose family incomes are below 138 percent of poverty. Virtually all of these children are eligible for Medicaid coverage across the nation.  We compared outcomes for children living in 24 states with 12-month continuous eligibility policies to those living in 26 states (and the District of Columbia) without the policy.

Our multivariate analyses examined the effect of continuous eligibility on the outcomes after controlling for other relevant factors such as age, race/ethnicity, being foreign-born, having special health needs, and other Medicaid policies, such as income eligibility levels for parents and children. Continuous Medicaid eligibility is associated with:

• Raising the number of children who saw a specialist in the past year by 1.5 percentage points, which is equivalent to a one-eighth increase in access to specialists,
• Reducing unmet needs for specialty care by 6.0 percent, lowering the level of unmet needs by about one-third,
• Increasing the use of preventive care visits in the past year by 2.7 percentage points (marginally significant), equivalent to reducing the number without a preventive visit by about one-tenth,
• Reducing gaps in insurance coverage by 2.4 percentage points, equivalent to reducing the number with a gap by almost one-fifth, and
• Lowering gaps caused by application problems by 1 percentage point, almost halving the number with gaps due to application problems.

Further analyses were conducted for the subset of children with special health care needs, those whose parents reported they had chronic health problems. For these vulnerable children, continuous eligibility was associated with statistically significant increases in the number of children able to obtain general medical care, preventive care and specialty care.

We also found that broader Medicaid eligibility for parents and for children were often associated with positive outcomes for the children. Higher Medicaid eligibility levels for both parents and children may facilitate greater enrollment in Medicaid and reduce the risk of coverage loss. The analyses identified special challenges for immigrant (foreign-born) children, who had less insurance coverage and less medical care. This may be due to eligibility policies that bar many immigrant children from Medicaid coverage, such as recent public charge regulations by the Department of Homeland Security.

The Families First Coronavirus Response Act called on states to provide continuous coverage to Medicaid enrollees during the period of the public health emergency. But even after the public health emergency ends, the nation will experience higher unemployment, greater poverty and economic volatility. Policies like 12-month continuous Medicaid eligibility and expanded eligibility could lower insurance gaps and assure better access to care for a longer period.

View the full report here.