The Effects of Public Health Insurance Expansions on the Mental and Behavioral Health of Children

In this paper, we examine the effect of public health insurance expansions during 1997-2002 on the mental and behavioral health of children. Using three waves of the National Survey of America’s Families (NSAF) and legislative State Children’s Health Insurance Program (SCHIP) and Medicaid income eligibility thresholds by state-year-age, we explore the causal impact of public health insurance generosity on participation, general health care utilization, mental health services utilization, and finally children’s mental and behavioral health measures. Our results first confirm that expanded eligibility significantly increased public health insurance coverage and general health care utilization. However, there is almost no statistically significant evidence of increases in mental health care utilization or improvements in general mental health outcomes for the whole sample, despite improved access to mental health coverage. When we focus on the thirteen Assessing the New Federalism (ANF) “study states” that comprise the bulk of the NSAF sample, we find a bit more evidence that insurance expansions may have slightly increased the probability of receiving mental health care as well as a few specific mental health outcomes for some age groups, but overall estimated effects remain small.