Related Research and Policy Resources

Health and Development Policies

Profile benchmarks for improving access to children’s public health insurance

  • State sets the income eligibility limit for public health insurance (Medicaid/CHIP) at or above 200% of the federal poverty level (FPL)
  • State provides 12-month continuous eligibility for both Medicaid and CHIP

In 2019, 8 percent of US children under age 6 lacked health insurance. Across the state, this percentage ranges from 2% (MA, HI) to 15% (TX).1 Research has shown that strengthening public health insurance access for children produces not only gains in health outcomes and family finances but also government cost savings and greater future financial security for children.2-5

  • Studies of state and federal expansions of Medicaid coverage demonstrate that these programs increase health care use and improve the health of children and educational outcomes of children.2
  • Public health insurance also reduces out-of-pocket medical spending and increases financial stability for families.3
  • Recent analyses indicate that each dollar spent on Medicaid generates at least $12.66 in benefits. Benefits to government include cost savings from reduced emergency visits and hospitalizations, and higher future taxes paid by children.2, 4
  • Providing continuous health insurance coverage can help avoid interruptions in preventive care, reduce costly emergency care due to coverage gaps, and decrease the administrative burden for states (e.g., costs of handling changes in circumstances or processing terminations).5
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Profile benchmarks for improving access to maternal health and mental health

  • State Medicaid pays for maternal depression screening during pediatric/family medicine visits under the child’s Medicaid
  • State provides 12 months of postpartum Medicaid coverage for all eligible women
  • State has adopted Medicaid expansion as part of the Affordable Care Act
State Medicaid pays for maternal depression screening during pediatric/family medicine visits under the child’s Medicaid

Rates of maternal depression among low-income women with young children are high, ranging from 25% to 50%.6 Maternal depression in early childhood interferes with sensitive, responsive parenting and is associated with less optimal parent-child relationships, early development, and positive mental health outcomes.7, 8 Early detection and effective treatments can help alleviate depression and its negative impacts on children’s development.7, 9 Recognizing the harmful effects of maternal depression on children, many states’ Medicaid agencies recommend conducting four maternal depression screens during well-child visit in the first year based on suggestions from the American Academy of Pediatrics’ Bright Futures Medicaid EPSDT periodicity schedule.

Research has documented the benefits of maternal depression screening.6, 10, 11

  • Maternal depression screenings can improve rates of detection, referral, and treatment of postpartum depression in new mothers.10 For example, a recent study on addressing maternal depression through Home Visiting has found that screening interventions in Home Visiting programs (e.g., specifying policies and protocols for depression screening and home visitor response to screening results; tracking systems for screening, referral, and follow-up) increase screening rates and referrals to evidence-based treatments, helping reduce depressive symptoms among mothers with positive depression screens.6
  • A systematic review of studies on depression screening and treatment suggests that screening pregnant women and new mothers for depression may decrease depressive symptoms in women living with depression as well as reducing the occurrence of depression, especially in the presence of additional treatment supports (e.g., care management, treatment protocols, availability of trained clinicians).11
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State provides 12 months of postpartum Medicaid coverage for all eligible women

Medicaid covers almost half of all births in the country.12, 13 Providing Medicaid coverage for 12 months after delivery ensures that new mothers have access to health and mental health care, which can benefit both the mother and child.

Research suggests that postpartum Medicaid coverage could address critical health needs in the postpartum period.12, 14, 15

  • Postpartum care can address chronic conditions such as diabetes, as well as new conditions related to pregnancy and childbirth, such as postpartum depression.12 Also, dangerous postpartum conditions such as preeclampsia and blood clots may not emerge until weeks or months after delivery.15
  • About 29% of maternal deaths in the US occur between 43 and 365 days postpartum, many of which can be prevented with adequate, continuous postpartum care.15
  • Offering 12-month postpartum coverage is an important strategy to reduce disparities in health outcomes by race and ethnicity, including decreasing maternal morbidity and mortality.14
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State has adopted Medicaid expansion as part of the Affordable Care Act

Medicaid has been expanded to cover adults up to 138% of FPL in 39 states.16 This expansion has critical benefits for mothers and children in families that are most vulnerable to poor health outcomes.17-20

  • Research has found that when parents have Medicaid coverage, children are more likely to have both Medicaid coverage and to receive preventive health care.17, 18
  • States with Medicaid expansion reduce health insurance coverage disparities for children of color. In non-expansion states, over one-third of Hispanic infants were born to mothers without health insurance, while this percentage declined by about a half in expansion states.19 Analyses of the 2019 American Community Survey by the Kaiser Family Foundation also found lower child uninsured rates in expansion states compared to non-expansion states. About 6% of Black children lacked health insurance in non-expansion states, but the uninsured rate dropped to 3% in expansion states. The uninsured rate for Native Hawaiian/Other Pacific Islander children was 5% in expansion states, but the rate was 21% for this group of children in non-expansion states.20
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References:

1. NCCP analysis of 2015-2019 American Community Survey data

2. Currie, J., & Chorniy, A. (2021). Medicaid and Child Health Insurance Program improve child health and reduce poverty but face threats. Academic Pediatrics, 21(8), S146-S153. https://doi.org/10.1016/j.acap.2021.01.009

3. Wherry, L. R., Kenney, G. M., & Sommers, B. D. (2016). The role of public health insurance in reducing child poverty. Academic Pediatrics, 16(3), S98-S104. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034870/

4. Hendren, N., & Sprung-Keyer, B. (2019). A unified welfare analysis of government policies (NBER Working Paper No. 26144). National Bureau of Economic Research. https://www.nber.org/papers/w26144

5. Brooks, T., & Gardner, A. (2021). Continuous coverage in Medicaid and CHIP. Georgetown University Center for Children and Families. https://ccf.georgetown.edu/wp-content/uploads/2012/03/CE-program-snapshot.pdf

6. Tandon, D., Mackrain, M., Beeber, L., Topping-Tailby, N., Raska, M., & Arbour, M. (2020). Addressing maternal depression in home visiting: Findings from the home visiting collaborative improvement and innovation network. PloS One, 15(4), e0230211. https://doi.org/10.1371/journal.pone.0230211

7. Earls, M. F., Yogman, M. W., Mattson, G., Rafferty, J., Baum, R., Gambon, T., … & American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health. (2019). Incorporating recognition and management of perinatal depression into pediatric practice. Pediatrics, 143(1), e20183259. https://doi.org/10.1542/peds.2018-3259

8. Bernard, K., Nissim, G., Vaccaro, S., Harris, J. L., & Lindhiem, O. (2018). Association between maternal depression and maternal sensitivity from birth to 12 months: A meta-analysis. Attachment & Human Development, 20(6), 578-599. https://pubmed.ncbi.nlm.nih.gov/29374991/

9. van der Zee-van den Berg, A. I., Boere-Boonekamp, M. M., IJzerman, M. J., Haasnoot-Smallegange, R. M., & Reijneveld, S. A. (2017). Screening for postpartum depression in well-baby care settings: A systematic review. Maternal and Child Health Journal, 21(1), 9–20. https://doi.org/10.1007/s10995-016-2088-8

10. Bauman, B. L., Ko, J. Y., Cox, S., D’Angelo, MPH, D. V., Warner, L., Folger, S., Tevendale, H. D., Coy, K. C., Harrison, L., & Barfield, W. D. (2020). Vital signs: Postpartum depressive symptoms and provider discussions about perinatal depression — United States, 2018.  MMWR Morbidity and Mortality Weekly Report, 69(19), 575–581. https://doi.org/10.15585/mmwr.mm6919a2

11. O’Connor, E., Rossom, R. C., Henninger, M., Groom, H. C., & Burda, B. U. (2016). Primary care screening for and treatment of depression in pregnant and postpartum women: Evidence report and systematic review for the US preventive services task force. JAMA, 315(4):388–406. https://doi.org/10.1001/jama.2015.18948

12. Center for Medicare & Medicaid Services. (2021). Prenatal and postpartum care: Postpartum care. https://www.medicaid.gov/state-overviews/scorecard/postpartum-care/index.html

13. Kaiser Family Foundation. (2022). Medicaid postpartum coverage extension tracker. https://www.kff.org/medicaid/issue-brief/medicaid-postpartum-coverage-extension-tracker/

14. American Public Health Association. (2021). Expanding Medicaid coverage for birthing people to one year postpartum (Policy No. LB21-02). https://www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/Policy-Database/2022/01/07/Expanding-Medicaid-Coverage-for-Birthing-People-to-One-Year-Postpartum

15. The American College of Obstetricians and Gynecologists. (2022). Talking points: Extending Medicaid coverage for pregnant women beyond 60 days postpartum. https://www.acog.org/-/media/project/acog/acogorg/files/advocacy/talkingpoints-extending-medicaid-coverage-for-pregnant-women-beyond-60-days-postpartum.pdf

16. Kaiser Family Foundation. (2022). Status of state action on the Medicaid expansion decision. https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/

17. Venkataramani, M., Pollack, C. E., & Roberts, E. T. (2017). Spillover effects of adult Medicaid expansions on children’s use of preventive services. Pediatrics, 140(6). https://pediatrics.aappublications.org/content/140/6/e20170953

18. Schubel, J. (2021). Expanding Medicaid for parents improves coverage and health for both parents and children. Center on Budget and Policy Priorities. https://www.cbpp.org/research/health/expanding-medicaid-for-parents

19. Sanders, S. R., Cope, M. R., Park, P. N., Jeffery, W., & Jackson, J. E. (2020). Infants without health insurance: racial/ethnic and rural/urban disparities in infant households’ insurance coverage. PLoS One, 15(1), e0222387. https://doi.org/10.1371/journal.pone.0222387

20. Artiga, S., Hill, L., Orgera, K., & Damico, A. (2021). Health Coverage by Race and Ethnicity, 2010-2019. Kaiser Family Foundation. https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-by-race-and-ethnicity/

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