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Coverage and care consequences for families in which children have mixed eligibility for public insurance
1Julie L. Hudson (jhudson@ahrq.gov) is a senior economist in the Division of Modeling and Simulation, Center for Financing Access and Cost Trends, Agency for Healthcare Research and Quality, in Rockville, Maryland.
Insights
Children eligible for public health insurance in families with mixed eligibility (some siblings eligible, some not) face significant barriers. These children are more likely to be uninsured and receive less preventive care.
Area of Science:
- Health Services Research
- Public Health Policy
- Pediatric Health Insurance
Background:
- Public health insurance programs like Medicaid and the Children's Health Insurance Program (CHIP) are crucial for low-income children's healthcare access in the US.
- Mixed eligibility within a family, where some children are eligible for public insurance and others are not, presents a complex scenario for accessing care.
Purpose of the Study:
- To investigate the impact of mixed sibling eligibility on insurance coverage, healthcare access, and utilization among children eligible for public health insurance.
- To compare outcomes for eligible children in families with mixed-eligible siblings versus those in families with uniformly eligible siblings.
Main Methods:
- Utilized data from the Medical Expenditure Panel Survey (MEPS) Household Component (2001-2012).
- Examined insurance coverage, usual source of care, preventive dental visits, and well-child visits.
- Compared outcomes for eligible children in families with mixed-eligible siblings against those in families with all-eligible siblings.
Main Results:
- Eligible children in families with a mix of eligible and ineligible siblings were significantly more likely to be uninsured.
- These children demonstrated reduced access to a usual source of care and lower adherence to recommended preventive dental and well-child visits.
- No significant impact was observed for eligible children in families with mixed Medicaid-CHIP eligibility.
Conclusions:
- Mixed eligibility, specifically when involving ineligible siblings, creates substantial disadvantages for children eligible for public health insurance.
- Policies addressing these coverage gaps are needed to ensure equitable access to care and preventive services for all children.
- The findings highlight the complexities of navigating public insurance systems within families.
Abstract:
Public health insurance for low-income children in the United States is primarily available through Medicaid and the Children's Health Insurance Program (CHIP). Mixed eligibility occurs when there is a mix of either "Medicaid- and CHIP-eligible" children or a mix of "eligible (for public insurance) and ineligible (for public insurance)" children in the family. We used data from the Medical Expenditure Panel Survey (MEPS) Household Component for 2001-12 to examine insurance coverage, access to care, and health care use for eligible children in families with mixed-eligible siblings compared to those in families where all siblings were eligible for one program. We found that mixed eligibility has a significant dampening effect for eligible children in families with a mix of eligible and ineligible siblings. These children were more likely to be uninsured and less likely to have a usual source of care, less likely to have any preventive dental or well-child visits during the year, and less likely to fully adhere to recommended preventive dental and well-child visits than eligible children with all-Medicaid- or all-CHIP-eligible siblings. We found no significant impact for eligible children living in Medicaid-CHIP-mixed families.
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