Association for Public Policy Analysis & Management

A growing literature examines the effects of recent public health insurance eligibility expansions on financial well-being and public program participation. Much less is known, however, about how losing health insurance coverage affects these outcomes. In 2005, Tennessee disenrolled approximately 170,000 adults from its state’s Medicaid program, TennCare. Early research shows this contraction of the program reduced health insurance coverage, increased financial barriers to accessing medical care, shifted patients toward more expensive emergency department use, worsened self-reported health, and increased risk of delinquency and bankruptcy (Argys et al., 2017; DeLeire, 2018; Ghosh & Simon, 2015; Tarazi et al., 2017; Tello-Trillo, 2017). Two studies also report mixed results on labor supply effects (DeLeire, 2018; Garthwaite et al., 2014).

The group that was affected the most by the termination of eligibility was low-income adults without dependent children in the household (Garthwaite, Gross, and Notowidigdo, 2014). Since this group consists of many noncustodial parents who are responsible for paying child support, the disenrollment may have affected this population’s ability to pay their obligations. In this paper, we examine the contraction of public health insurance in Tennessee on child support receipt outcomes. Data come from the Current Population Survey (CPS) Child Support Supplement, which provides information on a variety of child support outcomes among a sample of individuals eligible to receive services from the Child Support program. We compare eligible individuals in Tennessee to a comparison groups before and after the termination of Medicaid eligibility.

Preliminary results suggest the TennCare disenrollment reduced the likelihood that a child support eligible custodial parent received any support payment by about 19 percent. Conditional on receiving any child support income, the amount received also decreased by about 33 percent. Evidence suggests these effects are likely because less child support is owed. These results are consistent with earlier work showing that Medicaid expansions to adults without dependent children increased the likelihood of an unmarried mother receiving child support by about 7 percent (Bullinger, 2019). This study is the first to examine the effects of a contraction of public health insurance on child support outcomes, and among the first to empirically study the relationship between the Medicaid and Child Support programs. These results can guide predictions of effects from public health insurance contractions and contribute to the discussion of how large public programs interact.