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Effects of Continuous Medicaid Coverage in 2020–2023 on Children's Health Insurance Coverage, Access to Care, Health Services Use by Type, and Health Status
Journal article   Open access   Peer reviewed

Effects of Continuous Medicaid Coverage in 2020–2023 on Children's Health Insurance Coverage, Access to Care, Health Services Use by Type, and Health Status

Wei Lyu and George L. Wehby
Health services research, Vol.61(1), e70034
02/2026
DOI: 10.1111/1475-6773.70034
PMCID: PMC12857483
PMID: 40887787
Appears in  UI Libraries Support Open Access
url
https://doi.org/10.1111/1475-6773.70034View
Published (Version of record) Open Access

Abstract

Objective: To examine the effects of continuous Medicaid coverage in 2020-2023 under the Families First Coronavirus Response Act (FFCRA) on children's health insurance coverage, access to care, likelihood of using healthcare services by type, and health status. Study setting and design: A difference-in-differences event study compares outcomes pre and post FFCRA between states without pre-FFCRA continuity provisions (treatment group) and those that required 12-month continuous coverage (control group). Data sources and analytical sample: The main sample includes 122,901-126,117 children (depending on outcome) aged 1-17 years with family income below 300% of federal poverty level from the 2016-2023 National Survey of Children's Health. Primary findings: After FFCRA, public coverage increased in treatment states in 2020, 2021, and 2022 by 4.1 (95% CI: 0.004, 8.3), 4.7 (95% CI, 0.4, 9.0), and 5.4 (95% CI: 2.0, 8.7) percentage points, respectively, relative to control states. Privately purchased coverage declined in 2020 by 3.5 (95% CI: -5.3, -1.7) percentage points. The likelihood of having a usual place for sick care increased by 3.6 (95% CI: 0.5, 6.8) percentage points in 2021, and the likelihood of unmet care needs decreased by 1.7 (95% CI: -2.8, -0.7) and 2.4 (95% CI: -3.8, -1.0) percentage points in 2021 and 2022. The likelihood of excellent/very good health increased by 2.5 (95% CI: 0.4, 4.5), 3.8 (95% CI: 0.7, 6.8), and 2.7 (95% CI: 0.4, 5.0) percentage points in 2020, 2021, and 2023, respectively. There were no changes in the likelihood of medical, preventive, mental health, specialist, and emergency department visits and hospital admissions. Conclusions: Medicaid continuity under the FFCRA increased the children's public coverage rate. Despite potential switching from private coverage, there is evidence for reductions in unmet care needs and improved health status. Findings provide insights into potential effects of recent federal requirements that all states provide 12-month Medicaid continuity for children.
 Medicaid access to care children health insurance coverage health status insurance continuity UIOWA OA Agreement

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