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Author Notes:

E. Kathleen Adams, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322-1007, USA. Email: eadam01@emory.edu

Drs. Adams, Johnston, Guy and Ketsche contributed to the conception, design, completion of the analysis and writing of the manuscript.

Mr. Joski and Dr. Guy completed the file construction, analytic runs and econometric analysis.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


Research Funding:

This work was supported by the Robert Wood Johnson Foundation (RWJF); Changes in Health Care Finance and Organization 9HCFO) initiative (ID: 71436 PI: Adams).


  • CHIP expansions
  • eligibility
  • family insurance

Children's Health Insurance Program Expansions: What Works for Families?


Journal Title:

Global Pediatric Health


Volume 6


, Pages 2333794X19840361-2333794X19840361

Type of Work:

Article | Final Publisher PDF


We examine the impact of Children's Health Insurance Program (CHIP) eligibility expansions 1999 to 2012 on child and joint parent/child insurance coverage. We use changes in state CHIP income eligibility levels and data from the Current Population Survey Annual Social and Economic Supplement to create child/parent dyads. We use logistic regression to estimate marginal effects of eligibility expansions on coverage in families with incomes below 300% federal poverty level (FPL) and, in turn, 150% to 300% FPL. The latter is the income range most expansions targeted. We find CHIP expansions increased public coverage among children in families 150% to 300% FPL by 2.5 percentage points (pp). We find increased joint parent/child coverage of 2.3 pp (P = .055) but only in states where the public eligibility levels for parent and child are within 50 pp. In these states, the CHIP expansion increased the probability that both parent/child are publicly insured (2.5 pp) among insured dyads, but where the eligibility levels are further apart (51-150 pp; >150 pp), CHIP expansions increase the probability of mixed coverage-one public, one private-by 0.9 to 1.5 pp. Overall, families made decisions regarding coverage that put the child first but parents took advantage of joint parent/child coverage when eligibility levels were close. Joint public parent/child coverage can have positive care-seeking effects as well as reduced financial burdens for low-income families.

Copyright information:

© The Author(s) 2019

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/).

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