Graduation Date

Spring 5-4-2019

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research, Administration, and Policy

First Advisor

Dr. Fernando A. Wilson

Second Advisor

Dr. Li-Wu Chen

Third Advisor

Dr. Jungyoon Kim

Fourth Advisor

Dr. Fang Yu


The Patient Protection and Affordable Care Act (ACA) of 2010 introduced programs to promote integrated pediatric healthcare delivery and to expand public health insurance (Medicaid) eligibility for adults from low-income families in the United States. This dissertation examined whether progress was made towards integration of healthcare delivery for children with developmental disabilities after the implementation of ACA, and also whether expansion of Medicaid for adults impacted the preventive care utilization and school absenteeism of children from low-income families. A cross-sectional study design was used to examine whether integration of pediatric healthcare delivery was accomplished and a quasi-experimental difference-in-differences approach was used to establish the causal impact of Medicaid expansion on children’s outcomes. From the findings of this study, it was concluded that much work still needed to be done to accomplish high-quality integration of pediatric healthcare delivery and that expansion of Medicaid eligibility for adults had positive impacts on children’s preventive care utilization and school absenteeism.

Available for download on Sunday, April 25, 2021