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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 15: Continuous and Adequate Insurance

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Strategy. Parental Health Insurance Expansions

Approach. Provide health insurance coverage for parents to increase the likelihood of insuring children.

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Overview. Numerous studies have implemented policies expanding public insurance eligibility or subsidizing private insurance for parents. There is a causal link between parents’ access to Medicaid coverage and their children’s coverage. Cross-state analyses demonstrate that public expansions without premiums and special subsidized plan expansions had the largest effects on parental coverage and increased the likelihood of jointly insuring the parent and child.1, 2

Evidence. Emerging. There is evidence that parental health insurance expansions have an effect on children’s coverage rates, but further research is needed to confirm effects. This strategy has been tested more than once and results trend positive overall. This strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Caregivers and children.

Outcome. Increase in coverage for parents and children. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the “Intervention Results” for each study.

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Provide health insurance coverage for parents to increase the likelihood of insuring children,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of states offering parental health insurance expansions.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of states offering parental health insurance expansions.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of families utilizing parental insurance expansions to gain coverage.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of families who gained coverage for both parents and children.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4):

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


1 DeVoe JE, Marino M, Angier H, O’Malley JP, Crawford C, Nelson C, Tillotson CJ, Bailey SR, Gallia C, Gold R. Effect of expanding Medicaid for parents on children’s health insurance coverage: lessons from the Oregon experiment. JAMA pediatrics. 2015 Jan 1;169(1):e143145-.

2 Guy GP, M Johnston E, Ketsche P, Joski P, Adams EK. The role of public and private insurance expansions and premiums for low-income parents. Medical care. 2017 Mar 1;55(3):236-43.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.