How low-income kids benefit when parents have healthcare

Parental Medicaid enrollment is linked to an increase in pediatric well-child visits for children in low-income families, according to a new study.

The study, published in Pediatrics, found that a parent being enrolled in Medicaid was associated with a 29 percentage point higher probability that low-income children received an annual well-child visit, compared to a child whose parent was not enrolled in Medicaid.

Three reasons

This could be due to various reasons, says lead study author Maya Venkataramani, MD, MPH, a professor at Johns Hopkins University School of Medicine in Baltimore, Maryland.

“First, parental Medicaid expansions could result in a ‘welcome mat’ effect: when parents receive Medicaid, their children may also be more likely to enroll in the program,” she says.

Second, Venkataramani says, parental insurance coverage could result in improvement in family financial status, which can enable children’s healthcare use.

“Third, when parents are able to enroll in insurance and engage with the health system for themselves, they may be more likely to engage in care-seeking for their children,” she says.

Venkataramani and colleagues used nationally representative data from the 2001–2013 

Medical Expenditure Panel Survey, and linked parents (with preference given to the mother) with their children. They focused on 50 622 parent-child dyads in low-income (less than 200% of the federal poverty level). Well-child visits were defined as those that occurred for the purposes of well-child care, as well as general check-ups or immunizations.

“We compared states that did versus did not expand Medicaid for parents in the 2,000s and assessed whether there were associated changes in well-child visits among low-income children,” Venkataramani says. “We used this variation in state Medicaid expansions to estimate the association of parental Medicaid coverage with well-child visits. Our analyses controlled for other factors that could affect children’s healthcare use as well, such as parental race, ethnicity and education and child age.”

Venkataramani says the study findings held even when the researchers took into account the child’s insurance status or examined the period prior to the ACA, further suggesting that indeed parental insurance coverage changes play in children’s healthcare receipt.

“Children in low-income families have low rates of preventive service use; our findings suggest that efforts to expand Medicaid or other insurance eligibility for low-income parents could help promote their child’s receipt of these important services,” she says.

For managed care executives, these study findings are pertinent in that they highlight the family-wide benefit of health insurance coverage, according to Venkataramani. “When low-income parents are insured, their children may benefit too. One way to help ensure that children receive recommended pediatric care is to make sure that parents have access to, and receive, affordable health insurance coverage as well,” she says.

Based on the study Venkataramani recommends that managed care executives consider the benefits of extending affordable insurance coverage among adults who are caregivers of children.

“Healthcare use in families is inter-related, and policies and programs that consider the family as a whole may be more beneficial than those that target either children or their parents independently,” she says.