Do Health Insurance Policies which Split Children within the Same Household into Different Publicly-financed Programs Affect Rates of Enrollment or Utilization of Basic Health Care Services?
A child’s eligibility for publicly-financed insurance is based upon household factors such as family income and state of residence, as well as a child’s own characteristics including age and citizenship status. As a result, eligibility policies can fracture children living in the same household into different eligibility categories for insurance programs.
This analysis considers two questions. First, it investigates whether children living in households in which siblings are split by eligibility into different insurance programs, or between eligibility and ineligibility, are more likely to be uninsured compared to children who are eligible for the same program as their siblings. Second, the analysis examines whether children who receive insurance from a different publicly-financed program compared to one or more siblings, including covered children who have uninsured siblings, have lower rates of utilization for basic health services compared to children with the same publicly-financed coverage as their siblings.
The 2008 Current Population Survey Annual Social and Economic Supplement is used for the eligibility analysis. The population consists of children who are eligible for Medicaid or CHIP, reside in states with separate CHIP programs, and live with at least one other child. The 2008 Survey of Income and Program Participation is used for the utilization analysis. The population consists of children who are enrolled in a publicly-financed insurance program and who live with at least one other child. The services examined include an annual physician visit, an annual dental visit, and use of dental sealants. Logistic regression is used for both analyses.
The eligibility analysis does not find a significant difference in the odds of being uninsured among children in split-eligible households compared to those in households in which all children are eligible for the same program. The second analysis finds that split-enrolled children have lower odds of having had a dental visit in the last year compared to children in uniformly-enrolled households, and the same odds of having had a physician visit and of having used dental sealants.
Two unexpected findings are notable. Children covered by CHIP had lower odds of having obtained each service compared to children with Medicaid. Children living in Medicaid Expansion states also appeared to have more equitable access to services across personal and household characteristics compared to children in separate CHIP states (although this was not examined for statistical significance).
These findings suggest that split-eligibility and split-enrollment do not pose the obstacle to children’s enrollment in coverage and access to care as hypothesized. Dental visits were the exception. Two unexpected findings raise questions about variations in access to care among children covered by publicly-financed insurance. Greater attention is warranted to explore ways in which Medicaid and Medicaid Expansion states may be outperforming CHIP and separate CHIP states, and how those lessons may be applied to improve both programs.