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PhD Thesis Ufuoma Ejughemre2.06 MB
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Dissertation
Three essays on effects of the continuous Medicaid coverage provision under the family first coronavirus response act on work, insurance coverage and healthcare access
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2026
Abstract
This dissertation examines the effects of the Medicaid continuous coverage provision under the Families First Coronavirus Response Act (FFCRA) and its subsequent unwinding on Medicaid coverage, work outcomes, and healthcare access among working-age adults in the United States. The FFCRA temporarily required states to maintain Medicaid enrollment without eligibility redeterminations during the COVID-19 public health emergency, substantially increasing coverage stability. Its expiration in 2023 led to the resumption of eligibility determinations and widespread disenrollment, creating a unique opportunity to study the effects of both coverage expansion through continuity and coverage loss through unwinding. The dissertation consists of three empirical analyses using nationally representative survey data and quasi-experimental methods. The first study evaluates the effects of extending postpartum Medicaid coverage beyond 60 days using data from the American Community Survey. Exploiting variation across states in the difference between pregnancy and non-pregnancy Medicaid eligibility thresholds, the results show that the policy significantly increased postpartum Medicaid coverage but had no meaningful effects on labor force participation, employment, hours worked, or full-time employment.
The second study examines the effects of the FFCRA continuous coverage provision and its unwinding on work outcomes among adults ages 19-64 using ACS data from 2016-2024. Using a continuous-treatment difference-in-differences event-study design based on geographic (county) variation in pre-pandemic Medicaid eligibility, the findings show that Medicaid coverage increased during the policy period but declined during the unwinding. Work outcomes remained largely unchanged during the coverage expansion period. Although some positive effects on employment and laborforce participation emerged during the unwinding period, these effects were economically modest suggesting limited evidence of meaningful labor supply responses.
The third study analyzes the effects of Medicaid unwinding on insurance coverage and healthcare access using data from the Behavioral Risk Factor Surveillance System. An interrupted time series design shows that Medicaid coverage declined substantially following the resumption of eligibility redeterminations. Although many individuals transitioned to alternative coverage sources, including marketplace and other public plans, the unwinding was associated with a decline in routine preventive care utilization.
Across all three analyses, the findings indicate that policies that stabilize Medicaid coverage can substantially increase insurance continuity without meaningfully reducing labor supply. In contrast, the unwinding of such policies leads to significant coverage loss and modest disruptions in healthcare utilization, even when some individuals obtain alternative coverage. These results provide new evidence on the relationship between public insurance and work incentives and highlight the importance of minimizing coverage disruptions in the design of Medicaid eligibility and renewal policies.
Details
- Title: Subtitle
- Three essays on effects of the continuous Medicaid coverage provision under the family first coronavirus response act on work, insurance coverage and healthcare access
- Creators
- Ufuoma Ejughemre
- Contributors
- George L Wehby (Advisor)Kanika Arora (Committee Member)William Story (Committee Member)Whitney Zahnd (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Health Management and Policy
- Date degree season
- Spring 2026
- Publisher
- University of Iowa
- Number of pages
- xii, 155 pages
- Copyright
- Copyright 2026 Ufuoma Ejughemre
- Language
- English
- Date submitted
- 04/24/2026
- Description illustrations
- color illustrations
- Description bibliographic
- Includes bibliographical references.
- Public Abstract (ETD)
Health insurance is essential for accessing care, maintaining health, and supporting workforce participation. Medicaid, the largest public insurance program in the United States, covers millions of low-income individuals, including pregnant women and working-age adults. During the COVID-19 pandemic, a federal policy allowed continuous Medicaid enrollment without routine eligibility checks, helping stabilize coverage during a period of economic uncertainty. In 2023, this policy ended, triggering the “Medicaid unwinding,” during which many individuals lost coverage or transitioned to other insurance.
This dissertation examines how extending Medicaid coverage and subsequently ending that extension affects employment and healthcare access. It consists of three studies. The first evaluates whether extended postpartum Medicaid coverage influences women’s participation in the workforce. The second examines the effects of the pandemic-era continuous coverage provision on employment among working-age adults. The third analyzes how the unwinding affected insurance coverage, access to care, and use of preventive services.
The findings indicate that extending Medicaid coverage provides stability without meaningfully reducing work. However, the end of continuous coverage led to significant disruptions in insurance. While many individuals transitioned to alternative coverage, these changes were associated with declines in routine care, such as annual checkups, suggesting that coverage instability can hinder consistent healthcare use.
Overall, this research underscores the importance of continuous and stable health insurance coverage for both economic and health outcomes. The findings are relevant for policymakers and healthcare administrators designing eligibility policies, renewal systems, and coverage transitions to minimize disruptions in care and workforce participation.
- Academic Unit
- Health Management and Policy
- Record Identifier
- 9985176974302771
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