Association for Public Policy Analysis & Management

The 2009 Children’s Health Insurance Program Reauthorization Act (CHIPRA) granted states the ability to expand Medicaid/CHIP eligibility to lawfully residing immigrant children who had lived in the U.S. for fewer than five years, which increased health insurance coverage among first-generation immigrant children in general. However, previous research has not examined whether the policy change had varying effects on the health insurance coverage and health among children of immigrants in different family structures. This is an important omission, as different levels of family resources may exacerbate or alleviate challenges that immigrant families face when obtaining coverage. Using data on a 51,536 children sample between the ages of 0-17 from the National Survey of Children’s Health (NSCH) from 2007 and 2011, this study examined the relationship between state variation in the expansion of Medicaid/CHIP and health insurance coverage, health care service utilization, and health among children in single and cohabiting parent families of different immigrant generations. Using Difference-in-Difference-in-Differences (D-D-D) estimation guided by Andersen’s (1995) Behavioral Model, this study estimated average changes in outcomes in states that expanded eligibility before and after CHIPRA among married-, cohabiting-, and single-parent families of different immigrant generations.

This study found that first-generation children of single and cohabiting parents residing in eligibility expansion states had the greatest gains in overall and public health insurance coverage through Medicaid/CHIP expansion, and the policy change had positive spillover effects on overall health insurance coverage among second-generation children in single-parent families. The study also found that the policy change was significantly associated with improved general health and dental health among children of immigrants. However, the study did not find evidence that policy treatment was associated with children’s health care service utilization, a result that requires further research. The findings of this study have practical meaning under the current political climate.