Parental Health Insurance Coverage as Child Health Policy: Evidence from the Literature

One of the policy questions expected to receive considerable attention during the State Children\u27s Health Insurance Program (SCHIP) reauthorization process is whether — and if so, under what circumstances — to permit states to use SCHIP funds to cover parents. In 2006, the average Medicaid income eligibility level for coverage of working parents stood at 65% of the federal poverty level, and 15 states and the District of Columbia set income eligibility levels for this group at 100 percent of the federal poverty level or higher.1 In 2005, 8 states used some portion of their SCHIP allotment funding, in combination with federal waiver authority under §1115 of the Social Security Act, to extend coverage to parents of SCHIP or Medicaid-enrolled children who are not themselves eligible for Medicaid or SCHIP. In addition, five states extended assistance to pregnant women otherwise ineligible for SCHIP or Medicaid by covering their unborn children. This analysis examines research published since 2000 that explores the relationship between public health insurance coverage of parents and the rate and effectiveness of coverage among children, as measured by insurance levels, coverage continuity, and appropriate use of pediatric health care. The analysis begins with a brief overview of current Medicaid and SCHIP coverage options for parents and children. It then summarizes key findings from the literature related to the impact of covering parents on children\u27s insurance enrollment. The analysis concludes with a discussion of the implications of existing studies for the question of whether to expand state flexibility to use federal SCHIP allotments to cover parents