Children's Health Insurance Program Expansions: What Works for Families?

Abstract

We examine the impact of Children's Health Insurance Program (CHIP) eligibility expansions 1999 to 2012 on child and joint parent/child insurance coverage. We use changes in state CHIP income eligibility levels and data from the Current Population Survey Annual Social and Economic Supplement to create child/parent dyads. We use logistic regression to estimate marginal effects of eligibility expansions on coverage in families with incomes below 300% federal poverty level (FPL) and, in turn, 150% to 300% FPL. The latter is the income range most expansions targeted. We find CHIP expansions increased public coverage among children in families 150% to 300% FPL by 2.5 percentage points (pp). We find increased joint parent/child coverage of 2.3 pp (P = .055) but only in states where the public eligibility levels for parent and child are within 50 pp. In these states, the CHIP expansion increased the probability that both parent/child are publicly insured (2.5 pp) among insured dyads, but where the eligibility levels are further apart (51-150 pp; >150 pp), CHIP expansions increase the probability of mixed coverage-one public, one private-by 0.9 to 1.5 pp. Overall, families made decisions regarding coverage that put the child first but parents took advantage of joint parent/child coverage when eligibility levels were close. Joint public parent/child coverage can have positive care-seeking effects as well as reduced financial burdens for low-income families.

Keywords: CHIP expansions; eligibility; family insurance.

Figure 1.

Expansions of children’s eligibility for public insurance >25% federal poverty level, 1999 to 2012. Source: Authors’ analysis of state eligibility policies. (see Appendix Table A1). Gray bars denote the states’ eligibility thresholds for 1999. Black bars denote the percentage point change of eligibility expansions 1999 to 2012. Together the gray and black bars denote 2012 eligibility levels. States expansions less than 25 percentage points of the federal poverty level were excluded. All eligibility levels are reported as percent of the federal poverty level.