Continuous Medicaid Eligibility, Child Insurance, and Health Care Use

Health insurance gaps are common among publicly insured children, undermining health care access and health. The Families First Coronavirus Response Act halted Medicaid disenrollments during the COVID-19 public health emergency (PHE), offering an opportunity to study the impact of continuous Medicaid eligibility on child health insurance coverage, health care access and use, and health.

Using 2016-2022 National Survey of Children's Health data (n = 182 910), we applied a difference-in-differences approach to compare changes in health insurance coverage gaps, health care access (unmet health care needs [any, mental health, and specialist]), health care use (preventive care, emergency department [ED]), and general health status before and during the PHE between publicly ("treated") and privately ("untreated") insured children. Adjusted models included child demographics, household characteristics, and state of residence. We also conducted subgroup analyses by child age and special health care need status.

Continuous Medicaid eligibility was associated with a 3.1 percentage point (pp) decrease in health insurance coverage gaps (95% CI, -3.9 to -2.3) and a 3.9 pp decrease in ED use (95% CI, -5.7 to -2.0) among publicly insured children. Among children with special health care needs (CSHCN), continuous eligibility was associated with a larger decrease in ED use (-7.5 pp, 95% CI, -11.3 to -3.7) and was additionally associated with a 6.4 pp increase (95% CI, 2.7-10.1) in excellent general health status compared with children without special health care needs. No significant associations were observed with other indicators of health care access or use.

Policies promoting continuous Medicaid eligibility may improve child health care use and health through improved coverage consistency, particularly among CSHCN.