Effects of State Medicaid Expansions Affecting Parental Eligibility on Children’s Healthcare Access and Health During the COVID-19 Pandemic.

Publication date: Aug 07, 2026

To examine whether pre-pandemic state Medicaid expansions for adults affected children’s healthcare access and utilization, child health, and parental health during the COVID-19 pandemic. The sample includes children from households with incomes up to 138% of the Federal Poverty Level using data from the 2016-2023 National Survey of Children’s Health. Child outcomes include insurance coverage, usual place for sick care, personal doctor or nurse, unmet healthcare needs, past 12-month utilization of any medical services, preventive medical and dental visits, mental health professional treatments, non-mental health specialist visits, emergency department visits, hospitalizations, and general/oral health ratings. Parent outcomes include physical and mental health ratings. Difference-in-differences models estimate year-by-year differences in outcomes between Medicaid expansion and non-expansion states. There is a decline in usual place for sick care, personal doctor or nurse, and preventive medical visits in the first or second pandemic year and in child health in 2020/2023 in expansion versus non-expansion states. In contrast, there is an increase in mental health professional treatments and other specialist visits in 2021-2023 in expansion states. Lastly, there are declines in maternal physical/mental health and father’s mental health in 2020 but increase in father’s mental/physical health in 2023 in expansion states. During the pandemic, children in low-income households had less care continuity and preventive care but more mental health treatments and non-mental specialist visits in Medicaid expansion versus non-expansion states. There were also declines in both child and parent health. Findings potentially reflect intertwined effects from greater parental coverage but more pandemic-related social mobility restrictions disrupting routine/preventive care and worsening mental health more in expansion states.

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