203 - State Medicaid Policies for Undocumented Children and The Role of Migrant and Seasonal Head Start in Promoting Health: Analysis of the Migrant and Seasonal Head Start Survey​

Publication Number: 203.6750

Veronika Shabanova, Yale School of Medicine, New Haven, CT, United States; Julia Rosenberg, Yale University, New Haven, CT, United States

Background: Childhood health insurance is associated with short- and long-term health and economic benefits. Only some US states offer Medicaid eligibility regardless of documentation status. In 2019, 28% of the 2.3 million immigrant children who were income-eligible for public health insurance and 12% of children reported in the National Agriculture Workers Survey were uninsured. State-level Migrant Seasonal Head Start (MSHS) programs help bridge gaps in health care access, care navigation, and health-related social needs (HRSNs).

Objective: Evaluate disparities in medical and dental health care access, behavioral and physical health status, and HRSN outcomes for children enrolled in MSHS in states with and without Medicaid eligibility for children regardless of documentation status and explore the role MSHS supports in mediating and moderating health-related outcomes.

Design/Methods: In this cross-sectional analysis of 2017 MSHS data, we assessed the association between Medicaid expansion regardless of documentation status (Figure 1) on health access (forgone medical and dental care), health status (overweight/obesity, development delays), and HRSNs (food and financial insecurity) using weighted Poisson regressions, adjusted for covariates, with 95% Confidence Intervals (CI) using Jackknife method. Mediation and moderation analyses evaluated MSHS interventions and supports.

Results: Sociodemographic characteristics are noted in Table 1. Lower levels of financial insecurity were reported in expanded-eligibility states (p=0.04; Figure 2). While not reaching level of statistical significance, children in non-expanded-eligibility states had higher prevalence of forgone medical care, overweight/obesity, and developmental delays, but lower prevalence of forgone dental care (Figure 2). Provision of MSHS supports was higher in states without expanded eligibility (Table 1), which in turn mediated level of forgone dental care (33% excess risk). MSHS services were found to be effect modifiers of the association between Medicaid expansion and prevalence of obesity/overweight (p=0.10), developmental delay (p=0.02) and food insecurity (p=0.10).

Conclusion(s): Families of children enrolled in MSHS in states without extended Medicaid eligibility for children regardless of documentation status had higher prevalence of forgone care, overweight/obesity, development delays, and financial insecurity but lower prevalence of missed dental visits. MSHS supports can fill gaps in care, especially in states with limited resources (such as those without Medicaid expansion), reflecting importance of Head Start services for health and wellbeing.

Figure 1. States with vs without public health insurance (Medicaid) eligibility for children regardless of documentation status
Figure 1.pdf

Figure 2: Adjusted Outcomes by States with and without Extended Medicaid Eligibility
Figure 2.pdfAdjusted for caregiver age, relationship to child, ethnicity, education, country of birth, English proficiency, and child sex. Abbreviations: PR = prevalence ratio. 95%CI = 95% Confidence interval

Table 1. Sociodemographic characteristics and Migrant Seasonal Head Start supports by state type (with and without extended public health insurance eligibility)
Table 1.pdfAbbreviations: MSHS=Migrant Seasonal Head Start, GED=General Educational Development, SNAP=Supplemental Nutrition Assistance Program, WIC=Special Supplemental Nutrition Program for Women, Infants and Children