Children Welcome, Adults Need Not Apply: Changes in Public Program Enrollment across States and over Time

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Abstract
This article describes changes in the extent of public health insurance coverage for low-income children and adults from 1979 through 2001. Although previous research has demonstrated that public coverage among children has increased substantially during the past 20 years, our work shows that almost all of the increase has occurred among children in families with incomes between 100% and 200% of the federal poverty level (FPL), with little change among children in families with incomes below 100% of FPL. In contrast to the increase in public coverage among children, there has been virtually no change in the generosity of public programs for low-income adults. The overall stability of public coverage for adults masks substantial changes at the state level: public coverage for adults increased substantially in Tennessee, Vermont, Arizona, and other states that implemented Section 1115 Medicaid waivers, while declining in New York, California, and many Rust Belt states.