The effect of adult HIFA waiver expansions on insurance coverage of children

Adam Atherly, Robert F. Coulam, Bryan E. Dowd, Gery Guy

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


This article evaluates the effect of the Health Insurance Flexibility and Accountability (HIFA) demonstrations on uninsurance rates among children. HIFA could increase the probability that children would have health insurance either by directly enrolling a child into a HIFA program or by creating a "spillover" effect from adults onto children by making parents of children already eligible for public programs eligible for HIFA. Data were drawn from the Current Population Survey from 2000 to 2007. The estimation approach was a probit model using a difference-in-differences approach. The authors find that the HIFA wavier demonstrations had no measureable effect on the uninsurance rate among children, either through direct eligibility or through a "spillover" effect from parental eligibility. This suggests that public programs that integrate family insurance coverage into a single structure are likely to be more effective at reducing the rate of uninsurance than different programs for different members of the same family.

Original languageEnglish (US)
Pages (from-to)397-413
Number of pages17
JournalMedical Care Research and Review
Issue number4
StatePublished - Aug 2012


  • Medicaid
  • children
  • uninsurance


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