More Children Gained Coverage Through Medicaid-Eligible Parents

An additional 710,000 low-income children enrolled in Medicaid after the implementation of the Affordable Care Act (ACA), according to an article by AHRQ researchers in Heath Affairs. These increases occurred among children who were already eligible for Medicaid before the ACA. Study authors used data from the American Community Survey to explore this “welcome mat” effect in Medicaid. They found that by 2015, Medicaid-eligible children in families with incomes below 138 percent of poverty were more likely to be enrolled in public coverage than in 2013. This was true among all previously Medicaid-eligible children in their study, but the effects were largest among children whose parents had gained eligibility for public insurance through the Medicaid expansion to low-income adults. Access the abstract.

Medicaid Expansion For Adults Had Measurable ‘Welcome Mat’ Effects On Their Children

Julie L. Hudson1,* and
Asako S. Moriya2,*

+Author Affiliations

¹Julie L. Hudson (jhudson@ahrq.gov) is a senior economist in the Division of Research and Modeling, Center for Financing Access and Cost Trends, Agency for Healthcare Research and Quality (AHRQ), in Rockville, Maryland.
²Asako S. Moriya (Asako.Moriya@ahrq.hhs.gov) is an economist in the Division of Research and Modeling, Center for Financing Access and Cost Trends, AHRQ.

↵*Corresponding author
↵*Corresponding author

Abstract

Before the implementation of the Affordable Care Act (ACA), most children in low-income families were already eligible for public insurance through Medicaid or the Children’s Health Insurance Program. Increased coverage observed for these children since the ACA’s implementation suggest that the legislation potentially had important spillover or “welcome mat” effects on the number of eligible children enrolled. This study used data from the 2013–15 American Community Survey to provide the first national-level (analytical) estimates of welcome-mat effects on children’s coverage post ACA. We estimated that 710,000 low-income children gained coverage through these effects. The study was also the first to show a link between parents’ eligibility for Medicaid and welcome-mat effects for their children under the ACA. Welcome-mat effects were largest among children whose parents gained Medicaid eligibility under the ACA expansion to adults. Public coverage for these children increased by 5.7 percentage points—more than double the 2.7-percentage-point increase observed among children whose parents were ineligible for Medicaid both pre and post ACA. Finally, we estimated that if all states had adopted the Medicaid expansion, an additional 200,000 low-income children would have gained coverage.