Expansion of Health Insurance Eligibility and Changes in Health Care Access for Children

PROJECT SUMMARY Uninsured children, many of whom are children in immigrant families—who have at least one parent born outside the US and make up over 25% of the US child population—may experience more health problems and may have limited health care access compared with children enrolled in health insurance. In 2019, when 6% of US children were uninsured overall, 28% of immigrant children were uninsured. Outreach and support that enable children to enroll in health insurance, along with as multilevel outreach efforts that promote enrollment in health services for which families are eligible, are urgently needed to increase access to health care and improve health outcomes for children. Dr. Julia Rosenberg is an Assistant Professor of Pediatrics at Yale University whose career goal is to become an independent investigator who applies community-engaged principles to evaluate and inform multi-level health interventions to improve health for children. Alongside her multidisciplinary mentorship team, Dr. Rosenberg has devised a career development plan for this proposed K23 award that will promote her successful transition to independence through formal coursework and mentorship in: (1) repeated cross-sectional analysis, longitudinal quantitative analysis, and causal inference; (2) economic evaluations; (3) mixed methods research; (4) grant and scientific writing; and (5) ethical research principles in community-based participatory research. The objectives of the proposed study that will accompany the career development plan are to evaluate the extent to which new health insurance eligibility opportunities are associated with changes in uninsurance and in utilization of preventive health care and to employ community-based participatory research methodology to identify multilevel barriers to and facilitators of healthcare-seeking behavior for families. In Aim 1, we will use repeated cross-sectional data from the National Survey of Children’s Health to determine the extent to which state-level health insurance eligibility opportunities are associated with changes in health insurance enrollment and utilization of preventive health care. In Aim 2, we will use electronic health record data to evaluate difference-in-differences of uninsurance, utilization of preventive health care, and health care costs for children within vs. outside the limited age range of expanded eligibility in Connecticut (≤12 years old vs. >12 years old). In Aim 3, we will apply the NIMHD research and socioecological frameworks to assess multilevel (individual, interpersonal, community, and societal) barriers to and facilitators of changes in healthcare-seeking behavior and health services use for families by conducting qualitative assessments of public hearing testimonies and completing interviews with key informants from the community via purposive sampling. Results from this evaluation can inform future support and outreach efforts to improve health for children and families and will establish a foundation for future multi-state, longitudinal evaluations of long-term health and economic outcomes related to health insurance eligibility expansion.