Abstract
Objective
To examine the effects of parental Medicaid eligibility on parental health, parenting
practices, and child development in low-income families.
Methods
Longitudinal analysis using data from the Early Child Longitudinal Study-Kindergarten:
2011 to 2016. Outcomes included parental self-rated health, parental depressive symptoms,
parents’ communication and warmth toward children, and children's social skills and
externalizing and internalizing behaviors. We estimated 2-way (individual and year)
fixed effects models using Medicaid eligibility as a continuous variable, controlling
for changing economic conditions, changes in family structure, and state-specific
trends. We then estimated triple difference models comparing lower income families
to those with higher incomes. Finally, we estimated difference-in-difference models
and used entropy weights in order to account for differences in trends prior to 2014
for some outcomes.
Results
In fixed effects models, expanding Medicaid eligibility by 100% of the federal poverty
line is associated with a 12.7 percentage point reduction in parents’ report of having
fair or poor health (95% confidence interval [CI], -23.9, -1.5) and a 1.15-point improvement
on a 12-point scale of parental warmth towards children (95% CI, 0.15, 2.16). Results
were substantively similar in entropy-balanced difference-in-differences models. In
triple difference models, expanded Medicaid eligibility is associated with a 0.46
point improvement in warmth (95% CI, 0.10, 0.83) but not improved parental health.
No significant effects for child behavior or other outcomes were detected.
Conclusions
Expanding Medicaid for parents may have implications for intergenerational family
functioning that could lead to broader social benefits.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic PediatricsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Parenting related to child and parental psychopathology: a descriptive review of the literature.Clin Child Psychol Psychiatry. 2002; 7: 529-552
- Supportive family environments ameliorate the link between racial discrimination and epigenetic aging: a replication across two longitudinal cohorts.Psychol Sci. 2016; 27: 530-541
- Putting parenting in perspective: a discussion of the contextual factors that shape parenting practices.J Child Fam Stud. 2002; 11: 255-269
- Ethnic variation in poverty and parenting stress.in: Deater-Deckard K Panneton R Parental Stress and Early Child Development: Adaptive and Maladaptive Outcomes. Springer International Publishing, 2017: 15-45
- Parental mental health and children's adjustment: the quality of marital interaction and parenting as mediating factors.J Child Psychol Psychiatry. 2003; 44: 227-241
- An interactionist perspective on the socioeconomic context of human development.Annu Rev Psychol. 2007; 58: 175-199
- The Effect of the Patient Protection and Affordable Care Act Medicaid Expansions on Financial Wellbeing.National Bureau of Economic Research, 2016https://doi.org/10.3386/w22170
- Medicaid expansion increased coverage, improved affordability, and reduced psychological distress for low-income parents.Health Aff. 2017; 36: 808-818
- The effect of parental Medicaid expansions on children’s health insurance coverage.Contemp Econ Policy. 2018; 37: 297-311
- Assessment of rates of child maltreatment in states with Medicaid expansion vs states without Medicaid expansion.JAMA Netw Open. 2019; 2e195529
Kaiser Family Foundation. Medicaid income eligibility limits for parents, 2002-2020. 2020. Available at: http://kff.org/medicaid/state-indicator/medicaid-income-eligibility-limits-for-parents/. Accessed November 12, 2020.
- Uninsurance and Medicaid/CHIP Participation among Children and Parents.Urban Institute, 2018 (Available at:)
- Love, discipline and elementary school achievement: the role of family emotional climate.Soc Sci Res. 2010; 39: 585-595
- Potential barriers to parent monitoring: social disadvantage, marital status, and maternal psychiatric disorder.J Am Acad Child Adolesc Psychiatry. 1996; 35: 1673-1682
- Associations of parenting styles and dimensions with academic achievement in children and adolescents: a meta-analysis.Educ Psychol Rev. 2016; 28: 475-493
- Enduring consequences of parenting for risk behaviors from adolescence into early adulthood.Soc Sci Med. 2008; 66: 2023-2034
- A prospective longitudinal study of high school dropouts examining multiple predictors across development.J Sch Psychol. 2000; 38: 525-549
- Unintentional injury in preschool boys with and without early onset of disruptive behavior.J Pediatr Psychol. 2002; 27: 727-737
- Early Childhood Longitudinal Study, Kindergarten Class of 2010-11, First-Grade and Second-Grade Psychometric Report.National Center for Education Statistics, Institute of Education Sciences, U.S. Department of Education, 2018 (Available at:) (Accessed January 21, 2019)
Kaiser Family Foundation. Medicaid and CHIP income eligibility limits for children as a percent of the federal poverty level. 2019. Available at: https://www.kff.org/health-reform/state-indicator/medicaid-and-chip-income-eligibility-limits-for-children-as-a-percent-of-the-federal-poverty-level/. Accessed January 25, 2019.
- Three-year impacts of the Affordable Care Act: improved medical care and health among low-income adults.Health Aff. 2017; (Published online)https://doi.org/10.1377/hlthaff.2017.0293
Goodman-Bacon A. Difference-in-Differences With Variation in Treatment Timing. National Bureau of Economic Research; 2018. Available at: https://www.nber.org/papers/w25018. Accessed September 3, 2021.
Kugler AD, Farooq A. Beyond job lock: impacts of public health insurance on occupational and industrial mobility; 2016. Available at: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2728331 Accessed August 5, 2020.
- How economic segregation affects children's educational attainment.Soc Forces. 2002; 81: 153-176
- The effect of high school socioeconomic, racial, and linguistic segregation on academic performance and school behaviors.Teachers College Record. 2015; 117
- Does it matter if teachers and schools match the student? Racial and ethnic disparities in problem behaviors.Soc Sci Res. 2013; 42: 1180-1190
- Teacher effects on social and behavioral skills in early elementary school.Sociol Educ. 2010; 83: 135-159
- The Effects of Medicaid Expansion Under the ACA: Updated Findings From a Literature Review.Kaiser Family Foundation, 2020 (Available at:) (Accessed June 16, 2020)
- Ebalance: a Stata package for entropy balancing.Soc Sci Res Netw. 2013; https://doi.org/10.2139/ssrn.1943090
- Expanding public health insurance to parents: effects on children's coverage under Medicaid.Health Serv Res. 2003; 38: 1283-1302
- Spillover effects of adult Medicaid expansions on children’s use of preventive services.Pediatrics. 2017; 140e20170953
- The relations of parental warmth and positive expressiveness to children's empathy-related responding and social functioning: a longitudinal study.Child Dev. 2002; 73: 893-915
- Parental physical illness as a risk for psychosocial maladjustment in children and adolescents: epidemiological findings from a national survey in Germany.Psychosomatics. 2007; 48: 476-481
Centers for Medicare & Medicaid Services (CMS). Maternal Opioid Misuse (MOM) model. 2020. Available at: https://innovation.cms.gov/innovation-models/maternal-opioid-misuse-model Accessed August 4, 2020.
- Two-generation programs and health.Future Child. 2014; 24: 79-97
Article Info
Publication History
Published online: July 25, 2021
Accepted:
July 20,
2021
Received:
October 5,
2020
Footnotes
The authors declare that there is no conflict of interest.
Identification
Copyright
Copyright © 2021 by Academic Pediatric Association
