Predictors of Children’s Health Insurance Coverage Discontinuity in 1998 Versus 2009: Parental Coverage Continuity Plays a Major Role

Jennifer E. DeVoe, Carrie J. Tillotson, Heather Angier, Lorraine S. Wallace

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


To identify predictors of coverage continuity for United States children and assess how they have changed in the first 12 years since implementation of the Children’s Health Insurance Program in 1997. Using data from the nationally-representative Medical Expenditure Panel Survey, we used logistic regression to identify predictors of discontinuity in 1998 and 2009 and compared differences between the 2 years. Having parents without continuous coverage was the greatest predictor of a child’s coverage gap in both 1998 and 2009. Compared to children with at least one parent continuously covered, children whose parents did not have continuous coverage had a significantly higher relative risk (RR) of a coverage gap [RR 17.96, 95 % confidence interval (CI) 14.48–22.29 in 1998; RR 12.88, 95 % CI 10.41–15.93 in 2009]. In adjusted models, parental continuous coverage was the only significant predictor of discontinuous coverage for children (with one exception in 2009). The magnitude of the pattern was higher for privately-insured children [adjusted relative risk (aRR) 29.17, 95 % CI 20.99–40.53 in 1998; aRR 25.54, 95 % CI 19.41–33.61 in 2009] than publicly-insured children (aRR 5.72, 95 % CI 4.06–8.06 in 1998; aRR 4.53, 95 % CI 3.40–6.04 in 2009). Parental coverage continuity has a major influence on children’s coverage continuity; this association remained even after public health insurance expansions for children. The Affordable Care Act will increase coverage for many adults; however, ‘churning’ on and off programs due to income fluctuations could result in coverage discontinuities for parents. If parental coverage instability persists, these discontinuities may continue to have a negative impact on children’s coverage stability as well.

Original languageEnglish (US)
Pages (from-to)889-896
Number of pages8
JournalMaternal and child health journal
Issue number4
StatePublished - Apr 2015


  • Access to care
  • CHIP
  • Child
  • Health insurance
  • Medicaid

ASJC Scopus subject areas

  • Epidemiology
  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health


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