State Policy Variation in Medicaid/Chip Expansion and Children of Immigrants in Cohabiting and Single Parent Families

Background and Purpose:

The 2009 Children’s Health Insurance Program Reauthorization Act (CHIPRA) granted states the ability to expand Medicaid/CHIP benefits to lawful immigrant children, which has successfully increased health insurance coverage among low-income 1^st generation families. However, no evidence is available on whether the policy impacts children of immigrants differently by family structure, which has profound implications for immigrant families whose family unit and family cohesion are particularly important in coping with challenges, including unfamiliarity with the U.S. healthcare system, limited healthcare accessibility, communication barrier, and policy restriction. By building on the empirical body of scholarship on CHIPRA and children of immigrants, this study has three specific aims: 1) to estimate policy effects on health insurance coverage among children of immigrants in cohabiting and single parent family structures, 2) to further examine whether this policy change affected children’s utilization of healthcare services and general health status, and 3) to investigate whether effects also extended to children of 2^nd generation and native families.

Method:

This study uses the National Survey of Children’s Health (NSCH) data, taking advantage of its state-level measures in 2007 and 2011, which allows for the estimation of the policy effects, enacted in 2009. The analysis includes 51,536 children between the ages of 0-17 with at least one parent. The outcomes consist of children’s a) overall and public health insurance coverage, b) medical and dental care service utilization, and c) general health and dental health status, all in a dichotomous form. By using Difference-in-Difference-in-Difference (D-D-D) estimation, this study examines average changes in outcomes in states that expanded eligibility before and after the policy treatment among married, cohabiting, and single parent families separately by immigrant generation. This study controls for multiple covariates.

Results:

This study finds that among 1^st generation families, eligibility expansion resulted in increases in overall health insurance coverage for children in single parent families (coefficient=0.225, p<0.05) and children in cohabiting parent families (coefficient=0.281, p<0.05) in states with eligibility expansion relative to those in states without expansion. Regarding 2^nd generation families, children of single parents in expansion states also experienced significantly improved overall insurance coverage by 0.15 points compared to their counterpart children in states without expansion (p<0.0001). However, children of single and cohabiting parents among native families in states that participated in expansion did not experience significant policy effects in any of the study’s outcomes, compared to their counterparts in states that did not.                 

Conclusions and Implications:

This study discovered that 1^st generation children of single and cohabiting parents had the greatest gains in overall health insurance coverage through Medicaid/CHIP expansion, and the policy intervention had positive spillover effects on overall health insurance coverage among 2^nd generation children in single parent families.  However, increase in insurance coverage did not improve children’s healthcare service utilization or health status, which requires further research. Despite 18 states not participating in CHIPRA as of January 2017, current efforts by other states should serve as a positive example for non-expansion states in improving insurance coverage for children of immigrants.