Young Children's Mental Health Improves Following Medicaid Expansion to Low-Income Adults

Published:September 16, 2022DOI:



      We investigate whether the Affordable Care Act's Medicaid expansion, implemented in 2014, improved the mental health of young children whose parents are in the policy's target population. We study children ages 2-3 in families with incomes less than 138 percent of the federal poverty level.


      We use restricted National Health Interview Survey data covering the United States from 2010 to 2018 to conduct an event study—a flexible version of difference-in-differences—of the Medicaid expansion's effects on Mental Health Indicator (MHI) values for young children. We estimate effects using ordered logit regression.


      Children's mental health was statistically significantly better in Medicaid expansion states, compared with non-expansion states, in three of four post-expansion years. There were no differences between expansion and non-expansion states in the pre-expansion period, lending support to the causal interpretation that the expansion improved children's mental health.


      While Medicaid expansion targets low-income adults, our evidence indicates it improves low-income children's mental health. The expansion is a two-generation investment in prevention. It helps lay a foundation for strong mental health in children's early years and beyond.


      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 access
      One-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 to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. The Henry J. Kaiser Family Foundation. Status of State Action on the Medicaid Expansion Decision. Published September 8, 2021. Accessed October 7, 2021.

        • Brevoort K
        • Grodzicki D
        • Hackmann MB.
        The credit consequences of unpaid medical bills.
        Journal of Public Economics. 2020; 187104203
        • Caswell KJ
        • Waidmann TA.
        The Affordable Care Act Medicaid Expansions and Personal Finance.
        Medical Care Research and Review. September 16, 2017; (Published online)
        • Goldman AL
        • Woolhandler S
        • Himmelstein DU
        • Bor DH
        • McCormick D.
        Out-of-Pocket Spending and Premium Contributions After Implementation of the Affordable Care Act.
        JAMA Internal Medicine. 2018; 178: 347
        • Finkelstein A
        • Taubman S
        • Wright B
        • et al.
        The Oregon Health Insurance Experiment: Evidence from the First Year.
        The Quarterly Journal of Economics. 2012; 127: 1057-1106
        • McMorrow S
        • Gates JA
        • Long SK
        • Kenney GM.
        Medicaid Expansion Increased Coverage, Improved Affordability, And Reduced Psychological Distress For Low-Income Parents.
        Health Affairs. 2017; 36: 808-818
        • McMorrow S
        • Kenney GM
        • Long SK
        • Goin DE.
        Medicaid Expansions from 1997 to 2009 Increased Coverage and Improved Access and Mental Health Outcomes for Low-Income Parents.
        Health Serv Res. 2016; 51: 1347-1367
        • Winkelman TNA
        • Chang VW.
        Medicaid Expansion, Mental Health, and Access to Care among Childless Adults with and without Chronic Conditions.
        Journal of General Internal Medicine. 2018; 33: 376-383
        • Baicker K
        • Allen HL
        • Wright BJ
        • Taubman SL
        • Finkelstein AN.
        The Effect of Medicaid on Management of Depression: Evidence From the Oregon Health Insurance Experiment.
        Milbank Q. 2018; 96: 29-56
        • Hudson JL
        • Moriya AS.
        Medicaid Expansion For Adults Had Measurable ‘Welcome Mat’ Effects On Their Children.
        Health Affairs. 2017; 36: 1643-1651
        • Weissman MM.
        Depression and Anxiety Disorders in Parents and Children: Results From the Yale Family Study.
        Archives of General Psychiatry. 1984; 41: 845
        • Cummings E
        • Keller PS
        • Davies PT.
        Towards a family process model of maternal and paternal depressive symptoms: exploring multiple relations with child and family functioning.
        Journal of Child Psychology and Psychiatry. 2005; 46: 479-489
        • Bhatt CB
        • Beck-Sagué CM.
        Medicaid Expansion and Infant Mortality in the United States.
        American Journal of Public Health. 2018; 108: 565-567
        • McGinty EE
        • Nair R
        • Assini-Meytin LC
        • Stuart EA
        • Letourneau EJ.
        Impact of Medicaid Expansion on Reported Incidents of Child Neglect and Physical Abuse.
        American Journal of Preventive Medicine. September 2021; (Published online)S0749379721004049
        • Brown ECB
        • Garrison MM
        • Bao H
        • Qu P
        • Jenny C
        • Rowhani-Rahbar A.
        Assessment of Rates of Child Maltreatment in States With Medicaid Expansion vs States Without Medicaid Expansion.
        JAMA Network Open. 2019; 2e195529
        • Beland L
        • Huh J
        • Kim D.
        The effect of Affordable Care Act Medicaid expansions on foster care admissions.
        Health Economics. August 31, 2021; (Published onlinehec.4419)
        • Carter AS.
        The Field of Toddler/Preschool Mental Health Has Arrived—On a Global Scale.
        Journal of the American Academy of Child & Adolescent Psychiatry. 2010; 49: 1181-1182
        • Briggs-Gowan MJ
        • Carter AS
        • Bosson-Heenan J
        • Guyer AE
        • Horwitz SM.
        Are Infant-Toddler Social-Emotional and Behavioral Problems Transient?.
        Journal of the American Academy of Child & Adolescent Psychiatry. 2006; 45: 849-858
        • Briggs-Gowan MJ
        • Carter AS.
        Social-Emotional Screening Status in Early Childhood Predicts Elementary School Outcomes.
        Pediatrics. 2008; 121: 957-962
        • Huffman LC
        • Baran J.
        Screening for Risk in a Primary Care Setting.
        in: DelCarmen-Wiggins R Carter AS The Oxford Handbook of Infant, Toddler, and Preschool Mental Health Assessment. Oxford University Press, 2020: 435-458
        • Arango C
        • Díaz-Caneja CM
        • McGorry PD
        • et al.
        Preventive strategies for mental health.
        The Lancet Psychiatry. 2018; 5: 591-604
      2. National Center for Health Statistics. National Health Interview Survey.

        • National Center for Health Statistics
        Technical Notes for Summary Health Statistics Tables: National Health Interview Survey.
        United States Centers for Disease Control and Prevention, 2018
      3. National Center for Health Statistics. Multiple Imputation of Family Income and Personal Earnings in the National Health Interview Survey: Methods and Examples.; 2016.

        • US Department of Health and Human Services
        Poverty Guidelines.
        ASPE, 2014 (Published November 23, 2015. Accessed May 22, 2019)
        • Achenbach TM
        • Edelbrock CS.
        Manual for the Child Behavior Checklist and Revised Child Behavior Profile.
        T.M. Achenbach, 1983
        • Ivanova MY
        • Achenbach TM
        • Rescorla LA
        • et al.
        Preschool Psychopathology Reported by Parents in 23 Societies: Testing the Seven-Syndrome Model of the Child Behavior Checklist for Ages 1.5–5.
        Journal of the American Academy of Child & Adolescent Psychiatry. 2010; 49: 1215-1224
        • Batra A
        • Hamad R.
        Short-term effects of the earned income tax credit on children's physical and mental health.
        Annals of Epidemiology. 2021; 58: 15-21
        • Simpson GA
        • Scott G
        • Henderson MJ
        • Manderscheid RW.
        Estimates of Attention, Cognitive, and Emotional Problems, and Health Service Use by US School-Age Children.
        in: Manderscheid RW Henderson MJ Mental Health. US Department of Health and Human Services, 2002
        • Achenbach TM
        • Edelbrock C
        • Howell CT.
        Empirically based assessment of the behavioral/emotional problems of 2- and 3- year-old children.
        J Abnorm Child Psychol. 1987; 15: 629-650
      4. Centers for Disease Control and Prevention. A Preliminary Evaluation and recommendations for use of the Mental Health Indicator in the NHIS. Published January 28, 2016. Accessed October 7, 2021.

        • Angrist JD
        • Pischke JS.
        Mostly Harmless Econometrics: An Empiricist's Companion.
        Princeton University Press, 2009
      5. US Bureau of Labor Statistics. Local Area Unemployment Statistics. Published 2019. Accessed March 18, 2022.