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Administrative Burdens and Child Medicaid Enrollments (WP-22-49)

Iris Arbogast, Anna Chorniy, and Janet Currie

Following decades of increasing child access to public health insurance, enrollments fell in many states between 2016 and 2019 and the number of uninsured children increased. This study provides the first national, quantitative assessment of the role of several common types of administrative burdens in driving the pre-pandemic drop in child health insurance coverage. In addition, the researchers undertake to identify the groups of children who were most affected by administrative burden. They show that regulations that increased administrative burdens placed on families reduced public health insurance coverage by a mean of 5.4 percent within the year following the implementation of these changes. Declines were largest for children without college educated parents, Hispanic families, and families with non-citizen parents. Declines in insurance coverage have been temporarily arrested by federal measures taken in response to the COVID-19 public health emergency. But unless policies increasing administrative burden are reconsidered, the decline in children’s public health insurance enrollments is likely to resume when the emergency declaration is lifted.

Iris Arbogast, Research Associate, Federal Reserve Bank of St. Louis

Anna Chorniy, Assistant Professor of Medical Social Sciences and IPR Associate, Northwestern University

Janet Currie, Henry Putnam Professor of Economics and Public Affairs, Princeton University

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