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Children’s Insurance Stability and Coverage Inequities During the COVID-19 Continuous Coverage Provisions

Date of Publication
March, 2025
Publication Type
Journal Article
Focus Area
License
Paid Access
DOI Entry
doi.org/10.2105/AJPH.2024.307900
Source
American Public Health Association
Citation (AMA)

Objectives. To explore the association between the March 2020 Families First Coronavirus Response Act (FFCRA) Medicaid disenrollment freeze during the COVID-19 public health emergency (PHE) and children’s insurance coverage by family income, race/ethnicity, and language.

Methods. We used 2015 to 2021 US Medical Expenditure Panel Survey data, comparing monthly coverage for publicly insured children before (2015–2019) and during (2020–2021) the PHE. Outcomes included continuous public coverage, private coverage, no coverage, total months of public coverage, and total number of uninsured months. We estimated weighted multivariable linear regression models with a PHE period indicator.

Results. The PHE was associated with an increase in continuous public coverage among children of 4.2% percentage points, reduced transitions to private coverage (−2.3 percentage points) and no insurance (−1.9 percentage points), and increases in months of public coverage. The largest continuous public coverage improvements were among children from families with incomes between 200% and 399% of the federal poverty level (FPL), non-Hispanic White children, and Hispanic children.

Conclusions. The FFCRA improved children’s public coverage continuity, particularly among children from families with incomes between 200% and 399% of the FPL, non-Hispanic White children, and Hispanic children, who may face coverage loss with disenrollment resuming.