Skip Navigation

Strengthen the Evidence for Maternal and Child Health Programs

Sign up for MCHalert eNewsletter

Evidence Tools
MCHbest. Adequate Insurance.

MCHbest Logo

Strategy. Parental Health Insurance Expansions

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

Return to main MCHbest page >>

Overview. Numerous studies have implemented policies expanding public insurance eligibility for 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 Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Health Outcomes. This strategy helps contribute to reducing avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease, disability, or mortality.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

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. Here are sample ESMs to use as models 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?")

PROCESS MEASURES:

  • Number of policies implemented to expand Medicaid eligibility for subsidized private insurance for parents. (Measures efforts to increase parental coverage options)
  • Number of enrollment assistance events for resources provided to help parents sign up for coverage. (Quantifies support for facilitating participation)

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

PROCESS MEASURES:

  • Percent of eligible parents who enroll in expanded Medicaid for subsidized private insurance. (Measures the uptake and participation rate among the focus population)
  • Percent of newly insured parents who receive information about enrolling their children in coverage. (Assesses the integration of parent and child outreach efforts)

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

PROCESS MEASURES:

  • Number of community-based organizations engaged as partners to promote parental health insurance expansions. (Leverages trusted messengers for outreach)
  • Number of providers trained to screen for and assist with parental health insurance enrollment. (Engages the healthcare sector in facilitating coverage)

OUTCOME MEASURES:

  • Number of well-child visits and immunizations received by children after their parents gain coverage. (Shows the link between parental coverage and pediatric preventive care)
  • Number of parents who adopt healthier behaviors after gaining access to coverage and preventive services. (Reflects potential for cascading health impacts)

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

PROCESS MEASURES:

  • Percent of families experiencing economic challenges who are aware of expanded parental coverage options. (Assesses the reach and saturation of outreach efforts)
  • Percent of parental coverage policies that are designed with input from families and community partners. (Reflects a commitment to policy development)

OUTCOME MEASURES:

  • Percent of newly insured parents who enroll their children in coverage within 6 months. (Shows the success rate of leveraging parental coverage for children)
  • Percent improvement in school attendance and academic performance among children whose parents gain coverage. (Reflects cross-sector impact on child well-being)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

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

References

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.