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

Abstract

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. (Am J Public Health. Published online ahead of print March 27, 2025:e1-e10. https://doi.org/10.2105/AJPH.2024.307900).