Associations of Expanding Parental Medicaid Eligibility and Parental Health and Family Functioning

• Published in: Academic pediatrics Vol. 22; no. 4; pp. 622 - 630
• Main Authors: Brantley, Erin, Darden, Michael, Ku, Leighton
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2022
• Subjects: Child; child health; Eligibility Determination; family functioning; Humans; Longitudinal Studies; Medicaid; Parent-Child Relations; Parenting; Parents; United States; United States; family functioning; child health; Medicaid; parenting
• ISSN: 1876-2859; 1876-2867
• DOI: 10.1016/j.acap.2021.07.017

To examine the effects of parental Medicaid eligibility on parental health, parenting practices, and child development in low-income families. 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. 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. Expanding Medicaid for parents may have implications for intergenerational family functioning that could lead to broader social benefits.