When low-income parents are enrolled in Medicaid, their children are much more likely to have yearly recommended healthcare visits, authors of a new study report.
That has important implications because the well-child visit is the primary setting for receiving growth and development screening, vaccinations, and medical guidance. The connection is particularly relevant as the future of the Affordable Care Act and Medicaid expansions are uncertain.
Well-child visits are recommended yearly for children 3 years of age and older — and more frequently for infants and toddlers. Prior research has shown that children who attend regular visits are more likely to complete vaccination schedules and avoid hospitalizations.
Maya Venkataramani, MD, MPH, from the Division of General Internal Medicine, Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues, examined the relationship among 50,622 parent-child pairs and their healthcare status from 2001 to 2013.
For the analysis, children aged 2 through 17 were matched with a biological parent, step-parent, or adoptive parent in the same household. The average age of the children in the study was 9.3 years, and the average age of the linked parents was 35.8 years. Most parents were white (72.5%) and non-Hispanic (67.4%), and most had at least a high school or general education diploma (67%).
The researchers found parental enrollment was linked with a 29–percentage point increase (95% confidence interval, 11 to 47 percentage points; P = .002) in the probability that their children would get an annual well-child visit. The parents had incomes below 200% of the federal poverty level.
Scheduling of well-child visits has been historically low, especially for low-income parents and those in racial or ethnic minority groups, the authors note.
They conclude that expanding Medicaid could potentially enhance child health and, conversely, that reducing Medicaid’s reach could have the opposite effect.
The findings were published online today in Pediatrics.
Possible Reasons for Link
The authors offer possible reasons for the link in parent-child coverage. One, supported by the Behavioral Model of Health Services, is that having insurance helps parents navigate the system for the whole family and may make parents more likely to schedule a well-visit appointment.
It could also be that when parents are covered and they’re not paying as much for healthcare out of pocket, there is more money to look into well-child visits, the authors reason.
In a sensitivity analysis, researchers controlled for whether the child was on Medicaid or the Children’s Health Insurance Program (CHIP) and found that this did not significantly affect results, “revealing that parental Medicaid enrollment affects [well-child visit] use independently of children’s insurance status,” they write.
This study points out a gap in effective coverage, writes Matthew M. Davis, MD, Division of Academic General Pediatrics and the Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois, in an accompanying editorial.
Whereas state and federal policies lean toward covering children in low-income households, they don’t always cover the parents.
“As recently as 2016, 89.6% of children had insurance coverage for the last 12 months, whereas only 80.5% of their parents had the same pattern,” Dr Davis writes.
Families Bear Risk Together
He points out that in private insurance markets the theory of coverage in the United States is that someone who pays premiums for coverage pays a small amount more to cover dependents in the same household.
“The central rationale for this paradigm is efficiency: family units are groups of individuals who bear the risks for health, and health care expenditures, together,” he writes.
He says the same principles should hold true for government programs such as Medicaid, pointing out that it’s the same family income that qualifies both parent and child for government programs.
He argues that Medicaid and CHIP should offer to cover parents of children on Medicaid at the same income thresholds under which their children qualify.
“If there is bipartisan sentiment that children deserve coverage that safeguards their health and wellbeing, then covering their parents can be an evidence-based way to maximize the value of that coverage,” he concludes.
The authors and editorialist have disclosed no relevant financial relationships.
Pediatrics. Published online November 13, 2017. Abstract, Editorial
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