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. 2022 Sep 1;150(3):e2022057034.
doi: 10.1542/peds.2022-057034.

Insurance and Health Care Outcomes in Regions Where Undocumented Children Are Medicaid-Eligible

Julia Rosenberg, Veronika Shabanova, Sarah McCollum, Mona Sharifi

Insurance and Health Care Outcomes in Regions Where Undocumented Children Are Medicaid-Eligible

Julia Rosenberg et al. Pediatrics. .

Abstract

Objectives: Expansion of insurance eligibility is associated with positive health outcomes. We compared uninsurance and health care utilization for (1) all children, and (2) children in immigrant families (CIF) and non-CIF who resided inside and outside of the seven US states/territories offering public health insurance to children regardless of documentation status ("extended-eligibility states/territories").

Methods: Using the cross-sectional, nationally representative National Survey of Children's Health-2019, we used survey-weighted, multivariable Poisson regression to assess the association of residence in nonextended- versus extended-eligibility states/territories with uninsurance and with health care utilization measures for (1) all children, and (2) CIF versus non-CIF, adjusting for demographic covariates.

Results: Of the 29 433 respondents, the 4035 (weighted 27.2%) children in extended- versus nonextended-eligibility states/territories were more likely to be CIF (27.4% vs 20.5%, P < .001), 12 to 17 years old (37.2% vs 33.2%, P = .048), non-White (60.1% vs 45.9%, P < .001), and have a non-English primary language (20.6% vs 11.1%, P < .001).The relative risk of uninsurance for children in nonextended- versus extended-eligibility states/territories was 2.0 (95% confidence interval 1.4-3.0), after adjusting for covariates. Fewer children in extended- versus nonextended-eligibility states/territories were uninsured (adjusted prevalence 3.7% vs 7.5%, P < .001), had forgone medical (2.2% vs 3.1%, P = .07) or dental care (17.1% vs 20.5%, P = .02), and had no preventive visit (14.3% vs 17.0%, P = .04). More CIF than non-CIF were uninsured, regardless of residence in nonextended- versus extended-eligibility states/territories: CIF 11.2% vs 5.7%, P < .001; non-CIF 6.1% vs 3.1% P < .001.

Conclusions: Residence in nonextended-eligibility states/territories, compared with in extended-eligibility states/territories, was associated with higher uninsurance and less preventive health care utilization.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLAIMER: The authors have indicated they have no conflicts of interest relevant to this article to disclose.

Figures

FIGURE 1
FIGURE 1
States/territories with extended eligibility and years of enactment, states/territories with nonextended eligibility, and states/territories with recently passed legislation to extend eligibility for public health insurance for undocumented children.
FIGURE 2
FIGURE 2
Adjusted negative health utilization outcomes for children from states/territories with and without extended insurance eligibility. *P <.05, ***P <.001. §Extended-coverage states/territories: California, Illinois, Massachusetts, Oregon, New York, Washington, and Washington, District of Columbia. Percent and 95% CI are survey weighted.
FIGURE 3
FIGURE 3
Adjusted RR of negative health utilization outcomes for children in nonextended-eligibility states, NSCH–2019. §Extended-coverage states/territories: California, Illinois, Massachusetts, Oregon, New York, Washington, and Washington, District of Columbia. Relative Risk (RR) and 95% confidence intervals.
FIGURE 4
FIGURE 4
Adjusted negative health utilization outcomes for children in immigrant families and children in nonimmigrant families from states/territories with and without extended insurance eligibility. *P <.05, ***P <.001. RR and 95% CI for those in nonextended compared with extended coverage states/territories. §Extended-coverage states/territories: California, Illinois, Massachusetts, Oregon, New York, Washington, and Washington, District of Columbia. Percent and 95% CIs survey weighted. †Child in immigrant family (CIF): US or foreign-born children with at least 1 parent/guardian born outside of the United States.
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