Low-income children are more likely to receive well-child care if their parents are enrolled in Medicaid, according to a new study.
The findings come as Congress debates the future of the program.
“Given evidence that increased access to pediatric care early in life is associated with improved health and lower hospital use in adulthood, changes in parental coverage may have long-term impacts on children that will be important to consider when modifying the Medicaid program,” authors wrote.
Medicaid covers about 17 million more adults since many states expanded coverage to those earning less than 138% of the federal poverty level under the Affordable Care Act (ACA), according to the study “Spillover Effects of Adult Medicaid Expansions on Children’s Use of Preventive Services” (Venkataramani M, et al. Pediatrics. Nov. 13, 2017, https://doi.org/10.1542/peds.2017-0953).
Researchers set out to see if adults’ coverage has an impact on whether their children attend well-child visits, which the Academy strongly recommendsso that doctors can immunize children, track their development, address concerns and provide guidance.
The team analyzed Medicaid Expenditure Panel Surveys from 2001-2013 on 50,622 low-income parent-child pairs. During that time, mean adult Medicaid eligibility rose from 73.5% of the poverty level to 107.7%. The percent of states with parental Medicaid eligibility limits greater than or equal to 200% of the poverty level also grew.
As adult Medicaid eligibility expanded, children participating in well-child visits increased from 32.7% in 2001 to 47.9% in 2013. Parental enrollment was associated with a 29-percentage point higher probability of a well-child visit, according to the study. Families with incomes between 100% and just below 200% of the poverty level saw the greatest increase.
Authors said the spillover effect may be due to Medicaid enrollment freeing up more of parents’ funds or helping them feel more comfortable with the health care system. The results did not change significantly after controlling for a child’s enrollment in Medicaid/Children’s Health Insurance Program (CHIP) or analyzing only the data from before the ACA took effect.
“These findings are of great significance given current uncertainty surrounding the future of the ACA and Medicaid expansions authorized by the law,” authors wrote. “Our work highlights the potential for Medicaid expansions targeting low-income adults to mitigate disparities in the receipt of WCV (well-child visits) between low and high income families.”
At the time of the study, 19 states had not expanded adult Medicaid to 138% of the poverty level. That included Maine, where voters approved expansion last week. In those states, the parents of about 5.5 million children would qualify for coverage if their state expanded the program, potentially resulting in 135,000 additional well-child visits, according to the study.
The Academy has repeatedly spoken out against cuts to Medicaid and called for bipartisan improvements to health care coverage, most urgently an extension of funding for CHIP, which covers nearly 9 million children and expired Sept. 30.
In a related commentary, Matthew M. Davis, M.D., MAPP, suggested that public insurance programs have the same income eligibility for adults and children.
“If there is bipartisan sentiment that children deserve coverage that safeguards their health and well-being, then covering their parent can be an evidence-based way to maximize the value of that coverage,” he wrote.
