Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Saad Omer



The relationship between coverage expansions and vaccination coverage is not well characterized, through previous work as linked coverage expansions with insurance rates and insurance rates with vaccination completion. We examined whether Medicaid expansions implemented by the end of 2015 in 29 states and D.C. were associated with changes in MMR vaccination and 7-series vaccination completion among low income children from 2010-2018.


Changes in mean vaccination coverage were compared between the four years before expansion (2010-2013) and the four years post expansion (2015-2018), using data from the 2010-2018 National Immunization Child Survey. The final study sample (N=36,591) included children with provider-confirmed records from families with incomes up to 138% of the federal poverty level with whom information on all relevant covariates was available. Outcomes were whether a child had completed the recommended 7-series vaccination sequence and whether a child had received 1 or more doses of MMR vaccine.


Medicaid expansion was not significantly associated with mean vaccination coverage for either MMR (difference-in-differences estimate, 0.82 percentage points, p=0.48) or 7-series vaccination completion (difference-in-differences estimate, -0.84 percentage points, p=0.65). Calendar time, age group of child, number of children in household, census region, and educational status of mother were significantly associated with changes in mean vaccination rate for both outcome measures.


This provides useful insight into the potential benefits of current public vaccination programs, but suggests their insufficiency in closing the vaccination gap between low income and high income children. Broad coverage expansions may not reduce vaccination disparities between low income and high-income children, and alternative solutions should be explored.

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