Coverage of Parents Helps Children, Too
End Notes
[1] If TMA expires on December 31, pre-existing rules, under which parents working their way off welfare received only four months of transitional coverage, will go into effect.
[2] Arkansas, New Mexico and Oregon provide SCHIP-funded coverage for parents under premium assistance programs, as compared to their regular SCHIP or Medicaid programs. Arkansas’ program is scheduled for implementation in 2007.
[3] Committee on the Consequences of Uninsurance, Institute of Medicine, Health Insurance Is a Family Matter, Washington, DC: National Academy Press, 2002.
[4] Donna Cohen Ross and Laura Cox, “In a Time of Growing Need: State Choices Influence Health Coverage Access for Children and Families,” Kaiser Commission on Medicaid and the Uninsured, Oct. 2005.
[5] States can expand Medicaid eligibility for parents beyond the limits used for state welfare programs; states may do so either under demonstration project waivers (based on Section 1115 of the Social Security Act) that are approved by the Centers for Medicaid and Medicare Services (CMS) or under Medicaid rules that allow states to use less restrictive methods to count income (and thereby effectively to raise Medicaid income limits for parents). Under Section 1115, states also may secure waivers to use a portion of their SCHIP funds to cover parents; to secure such a SCHIP waiver, a state must already extend SCHIP eligibility to children with incomes up to 200 percent of the poverty line.
[6] Both the CPS and the Center for Disease Control and Prevention’s National Health Interview Survey (NHIS) indicate that the percentage of low-income children who are uninsured has fallen substantially since 1997. The CPS data, reflected in Figure 1, show that the percentage of low-income children who are uninsured rose slightly in 2005, while the NHIS data indicate that the percentage of low-income children who are uninsured continued to decline in 2005. Although the general trends in the two surveys are similar, it is not clear why the CPS and NHIS results for 2005 diverge slightly.
[7] These statistics are based on CBPP analyses of the March 2006 Current Population Survey. Working families are defined as those earning more than $5,150 per year, the amount earned by working at the minimum wage for 1,000 hours in a year. The risk that a low-income parent is uninsured is similar whether a family resides in a central city, a suburb or a rural area.
[8] Leighton Ku and Matthew Broaddus, “The Importance of Family-based Insurance Expansions: New Research Findings about State Health Reforms,” Center on Budget and Policy Priorities, September 5, 2000.
[9] Lisa Dubay and Genevieve Kenney, “Expanding Public Health Insurance to Parents: Effects on Children’s Coverage Under Medicaid,” HSR: Health Services Research, 38(5):1283-1301, 2003. In a more detailed assessment of changes in Massachusetts, Dubay and Kenney similarly found that the state’s Medicaid expansion for parents resulted in increased Medicaid enrollment by eligible children and produced a significant decrease in the percentage of children who were uninsured.
[10] Anna Aizer and Jeffrey Grogger, “Parental Medicaid Expansions and Health Insurance Coverage,” NBER Working Paper 9907, August 2003.
[11] Barbara Wolfe and Scott Scrivner, “The Devil May Be in the Details: How the Characteristics of SCHIP Programs Affect Take-up,” Journal of Policy Analysis and Management, 24(3):499-522, 2005.
[12] Sylvia Guendelman, Megan Wier, Veronica Angulo and Doug Oman, “The Effects of Child-only Insurance Coverage and Family Coverage on Health Care Access and Use: Recent Findings Among Low-income Children in California,” HSR: Health Services Research, 41(1):125-47, Feb. 2006.
[13] Benjamin Sommers, “Insuring children or insuring families: Do parental and sibling coverage lead to improved retention of children in Medicaid and CHIP?” Journal of Health Economics, in press, 2006. (Accepted April 2006).
[14] See, for example, Judith Wooldridge, et al. “ Congressionally Mandated of the State Children’s Health Insurance Program: Final Report to Congress,” Mathematica Policy Research and the Urban Institute, Oct. 2005, Andrew Dick, et al., “SCHIP’s Impact in Three States: How Do the Most Vulnerable Children Fare,” Health Affairs, 23(5):63-75, Sept./Oct. 2004; Michael Seid, et al., “The Impact of Realized Access to Care on Health-Related Quality of Life: A Two-year Prospective Cohort Study in California’s State Children’s Health Insurance Program,” Journal of Pediatrics, 149: 254-6, Sept. 2006; Amy Davidoff, et al. “Effects of the State Children's Health Insurance Program Expansions on children with chronic health conditions,” Pediatrics. 2005 Jul;116(1):e34-42; Leighton Ku and Sashikala Nimalendran, “Improving Children’s Health: A Chartbook About the Roles of Medicaid and SCHIP,” Center on Budget and Policy Priorities, Jan. 2004.
[15] Amy Davidoff, Lisa Dubay, Genevieve Kenney and Alshadye Yemane, “The Effect of Parents’ Insurance Coverage on Access to Care for Low-income Children,” Inquiry, 40:254-268, Fall 2003.
[16] Elizabeth Gifford, Robert Weech-Maldonado, Pamela Farley Short, “Low-income Children’s Preventive Service Use: Implications of Parents’ Medicaid Status,” Health Care Financing Review, 26(4):81-94, Summer 2005.
[17] Sylvia Guendelman, op cit.
[18] Committee on the Consequences of Uninsurance, Institute of Medicine, op cit.
[19] Ibid.
[20] Mark Olfsson, et al. “Parental Depression, Child Mental Health Problems and Health Care Utilization,” Medical Care, 41(6):716-21, 2003.
[21] Jeanne Lambrew, “Health Insurance: A Family Affair” Commonwealth Fund, May 2001.
[22] Aizer and Grogger, op cit.
[23] Susan Busch and Noelia Duchovny, “Family Coverage Expansions: Impact on Insurance Coverage and Health Care Utilization of Parents,” Journal of Health Economics, 24:876-89-, 2005.
[24] Barbara Wolfe, Thomas Kaplan, Robert Haveman and Yoonyoung Cho, “SCHIP expansion and parental coverage: An evaluation of Wisconsin’s BadgerCare.” Journal of Health Economics (in press, 2006). Accepted Dec 2005. The quote is from an interview with Wolfe conducted by the University of Michigan’s Economic Research Initiative on the Uninsured, April 2005.
[25] Lisa Dubay and Genevieve Kenney, “Addressing Coverage Gaps for Low-income Parents,” Health Affairs, 23(2):225-234, Mar/Apr 2004.
[26] Busch and Duchovny, op cit.