Under the federal Affordable Care Act (ACA), California expanded eligibility for Medi-Cal, the state’s Medicaid program, to most non-elderly, non-disabled low-income adults. Although this change focused directly on improving the health and well-being of adults, it is likely that Medi-Cal expansion has had a dramatic effect on households with children.

In recent years, as the federal government has attempted to dismantle the ACA, California policymakers have continued to push forward with efforts to protect and expand coverage gains. A better understanding of the impact of adult Medi-Cal on child well-being can help inform state efforts to expand health care coverage and improve outcomes for low-income children and families.

In this report, we describe trends in health insurance coverage for California children and the adults they live and interact with. We also summarize recent research on the effects of Medicaid expansion for participating states on two broad areas that are particularly important for family well-being: financial security and behavioral health-including the prevention and treatment of mental health issues and substance use disorder. Key findings include:

• Uninsured rates among California’s low-income children have declined by more than 60 percent since the ACA coverage expansion. The share of children living with uninsured parents or other adults in their household also declined substantially.
• Despite these coverage gains, about 20 percent of low-income children continue to live with an uninsured parent. Among low-income children in households headed by non-citizen Latinos, these shares are substantially higher, with more than 40 percent continuing to live with an uninsured parent.
• There is strong evidence from national research that Medicaid expansion improved adults’ financial and behavioral health. Medicaid participants experienced fewer negative financial shocks such as “catastrophic” medical expenses, bills in collection, bankruptcy, and evictions. Broader financial health indicators, such as credit scores, also improved.
• In the area of behavioral health, research finds a reduction in depression symptoms. Medicaid covers the cost of additional behavioral-health-related prescription drugs and treatment, including medications for depression and opioid use disorder.

Given the longstanding associations of adult financial security, mental well-being, and the absence of addiction with positive child outcomes, it is likely that children are benefitting from the ACA’s Medicaid expansion. The national research is promising, but it is important to determine whether California’s Medi-Cal expansion is indeed leading to improvements in child mental health and welfare. In California, Latinos and non-citizens are especially likely to be uninsured, making it important to look at the distribution of improvements across the state’s population. As state policymakers seek to protect coverage gains while exploring options to expand insurance coverage to all Californians, a full assessment of the potential benefits of the Medi-Cal program is critical.