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Expanding the number of poor children eligible for Medicaid has increased access to care, but gaps remain

Between 1984 and 1990, Medicaid coverage expanded to include more children beyond those in the traditional welfare assistance population in order to improve the health and access to care of low-income children. As a result, the number of Medicaid-eligible children doubled. This Medicaid expansion did increase access of impoverished children to care, but gaps remain, conclude Jessica S. Banthin, Ph.D. and Thomas M. Selden, Ph.D. of the Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality.

The researchers examined the changes in children's access to care, family financial burdens, and health insurance coverage between 1987 (which largely predates the Medicaid expansions in coverage) and 1996. This is the first study to examine the change in financial burdens associated with the Medicaid expansions and one of only a few that have looked at changes in access to care in addition to coverage. The authors conducted their analysis using data from the 1996 Medical Expenditure Panel Survey and the 1987 National Medical Expenditure Survey.

Among eligible children, the Medicaid expansions reduced rates of uninsurance, increased access to physicians, and reduced families' risk of bearing a heavy financial burden. For instance, the percentage of eligible children who were uninsured the full year fell from 26 percent in 1987 to 16.1 percent in 1996, and more of this group had at least one visit to a doctor's office in 1996 than in 1987. Had the expansions not occurred, the study suggests that uninsurance rates would have risen instead to about 32 percent of eligible children uninsured for the full year in 1996. During this period, the proportion of Medicaid-expansion children whose families spent 10 percent or more of disposable family income on medical care dropped from 30.1 percent to 23.9 percent; yet 11.3 percent of the families still spent 20 percent or more of income on medical care in 1996.

Gaps remain between Medicaid expansion-eligible children and children from middle and upper income families who were never eligible for public coverage. Never-eligible children were less likely to be uninsured and more likely to have at least one visit to a doctor's office. Furthermore, while 11.3 percent of expansion-eligible children lived in families spending 20 percent or more of family income on medical care in 1996, this rate is much higher than the 1.7 percent of never-eligible children whose families spent 20 percent or more on medical care.

See "The ABCs of children's health care: How the Medicaid expansions affected access, burdens, and coverage between 1987 and 1996," by Drs. Banthin and Selden, in the Summer 2003 Inquiry 40, p. 133-145.

Reprints (AHRQ Publication No. 03-R061) are available from the AHRQ Publications Clearinghouse.

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