The Intergenerational Effects of Childhood Medicaid: Examining the Next Generation’s Health Using a Regression Discontinuity Design

This paper examines the long-reaching effects of childhood exposure to public health insurance by documenting the later life fertility decisions of women receiving expanded Medicaid coverage during childhood, as well as the health of their infants. Our research design takes advantage of variation in childhood eligibility for Medicaid by birthdate that resulted from a unique feature of Medicaid expansions in the late 1980s and early 1990s that applied only to children born after September 30, 1983. This feature of the expansions resulted in a large discontinuity in the cumulative number of years of eligibility during childhood experienced by children born just before and after this date. We take advantage of this variation using a regression discontinuity approach to estimate the long-term effects of childhood exposure to Medicaid on later fertility outcomes and the health of the next generation. We use restricted natality data files with information on mother’s date of birth to conduct our analyses. We examine the effects of childhood Medicaid separately for blacks and non-blacks after demonstrating that black children were more likely to benefit from these expansions. We find no evidence of effects of childhood Medicaid on later life fertility decisions for either group, but do find evidence suggesting improved health outcomes for the infants of black mothers who gained Medicaid during childhood. This paper is one of only a few studies examining whether the effects of an early health intervention may extend to future generations.