Children's Insurance Stability and Coverage Inequities During the COVID-19 Continuous Coverage Provisions

Area of Science:

• Public Health
• Health Policy
• Health Economics

Background:

• The COVID-19 public health emergency (PHE) prompted the Families First Coronavirus Response Act (FFCRA) in March 2020.
• FFCRA implemented a Medicaid disenrollment freeze, impacting children's health insurance continuity.
• Understanding the impact of this freeze on vulnerable populations is crucial for health equity.

Purpose of the Study:

• To examine the association between the FFCRA Medicaid disenrollment freeze and children's insurance coverage.
• To analyze coverage changes by family income, race/ethnicity, and language during the PHE.
• To identify specific subgroups of children who benefited most from the coverage protections.

Main Methods:

• Utilized US Medical Expenditure Panel Survey data from 2015-2021.
• Compared monthly insurance coverage for publicly insured children before (2015-2019) and during (2020-2021) the PHE.
• Employed weighted multivariable linear regression models to assess the impact of the PHE period.

Main Results:

• The PHE was linked to a 4.2% increase in continuous public coverage for children.
• Transitions to private coverage (-2.3%) and no insurance (-1.9%) decreased.
• Significant improvements in continuous public coverage were observed for children in families with incomes 200-399% of the Federal Poverty Level (FPL), and for Hispanic and non-Hispanic White children.

Conclusions:

• The FFCRA Medicaid freeze substantially improved children's public health insurance continuity.
• Coverage gains were most pronounced among children from families with incomes between 200-399% FPL, and Hispanic and non-Hispanic White children.
• These findings highlight potential coverage losses when disenrollment protections are lifted, emphasizing the need for targeted policy interventions.