The Spillover Effect of Medicaid Expansion on Children's Nutrition Security

About This Grant

PROJECT SUMMARY Low food security and diet-related diseases are a major public health concern and disproportionately impact families from low-income households. Too many families choose between paying for housing, utilities, food, and healthcare. To help fulfill these basic needs, Medicaid provides 39 million low-income households with children access to vital healthcare services for long-term health and well-being. To reach more individuals from low-income households, the Affordable Care Act (ACA) intended to expand Medicaid coverage to nearly all adults nationwide with incomes <138% of the federal poverty level, however the Supreme Court ruled that states could not be coerced to expand their Medicaid programs, effectively rendering the expansion optional. To date, most of the research on the ACA Medicaid expansion has focused on the policy’s impact on insurance coverage, access to and use of healthcare, and health among adults, as well as health insurance coverage for children. Our study will fill a critical gap in the literature by being the first to estimate the causal impact of ACA Medicaid expansion on food security and diet quality in children, an extremely important outcome because it is tied to physical growth and development, cognitive development, academic performance, and lifelong health. Our long-term goal is to inform strategies to promote food security through understanding the spillover effects of ACA Medicaid expansion on food security and diet quality in children. To achieve our goal, we will address 3 specific aims leveraging national data on low-income households with children with which we have extensive experience: 1) Examine whether ACA Medicaid expansion increased federal nutrition assistance participation in households with children using the Current Population Survey’s Annual Social and Economic Supplement (CPS-ASEC) and the Survey of Income and Program Participation (SIPP), a household panel survey; 2) Examine whether ACA Medicaid expansion improved food security in children using CPS-Food Security Supplement (CPS-FSS), the key source of food security status of U.S. children, and SIPP; and 3) Examine whether ACA Medicaid expansion increased household diet quality in children using the Circana National Consumer Panel, a household panel survey of detailed food purchases that can be linked to estimate overall nutritional quality of Americans’ food-at-home purchases. This will be the first study to comprehensively examine an important spillover effect of ACA Medicaid expansion on improving children’s food security and diet quality. Findings will help us understand the likely spillover effects of expanding Medicaid eligibility—or, as in more recent legislation, reducing Medicaid eligibility for parents—on nutrition outcomes for children from low- income households.