Low-Income Uninsured Children With Special Health Care Needs: Why Aren't They Enrolled in Public Health Insurance Programs?

Haley, Jennifer; Kenney, Genevieve M.

doi:10.1542/peds.2006-1726

Cited by 26 publications

(17 citation statements)

References 13 publications

(21 reference statements)

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“…The complexity of the application process can also be a barrier. A survey of parents indicated that although 93.5% had heard of the insurance programmes for their children, only 48.1% thought the application processes were easy (Haley 2007). In addition, the requirement for applicants for health insurance to travel to enrolment sites has proved to be a constraint for families in rural or isolated places (Langwell 2003).…”

Section: Introductionmentioning

confidence: 99%

Strategies for expanding health insurance coverage in vulnerable populations

Jia

Yuan

Huang

et al. 2014

Cochrane Database of Systematic Reviews

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Background Health insurance has the potential to improve access to health care and protect people from the financial risks of diseases. However, health insurance coverage is often low, particularly for people most in need of protection, including children and other vulnerable populations. Objectives To assess the effectiveness of strategies for expanding health insurance coverage in vulnerable populations. Search methods We searched Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library . www.thecochranelibrary.com (searched 2 November 2012), PubMed (searched 1 November 2012), EMBASE (searched 6 July 2012), Global Health (searched 6 July 2012), IBSS (searched 6 July 2012), WHO Library Database (WHOLIS) (searched 1 November 2012), IDEAS (searched 1 November 2012), ISI‐Proceedings (searched 1 November 2012),OpenGrey (changed from OpenSIGLE) (searched 1 November 2012), African Index Medicus (searched 1 November 2012), BLDS (searched 1 November 2012), Econlit (searched 1 November 2012), ELDIS (searched 1 November 2012), ERIC (searched 1 November 2012), HERDIN NeON Database (searched 1 November 2012), IndMED (searched 1 November 2012), JSTOR (searched 1 November 2012), LILACS(searched 1 November 2012), NTIS (searched 1 November 2012), PAIS (searched 6 July 2012), Popline (searched 1 November 2012), ProQuest Dissertation &Theses Database (searched 1 November 2012), PsycINFO (searched 6 July 2012), SSRN (searched 1 November 2012), Thai Index Medicus (searched 1 November 2012), World Bank (searched 2 November 2012), WanFang (searched 3 November 2012), China National Knowledge Infrastructure (CHKD‐CNKI) (searched 2 November 2012). In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via Web of Science to find other potentially relevant studies. Selection criteria Randomised controlled trials (RCTs), non‐randomised controlled trials (NRCTs), controlled before‐after (CBA) studies and Interrupted time series (ITS) studies that evaluated the effects of strategies on increasing health insurance coverage for vulnerable populations. We defined strategies as measures to improve the enrolment of vulnerable populations into health insurance schemes. Two categories and six specified strategies were identified as the interventions. Data collection and analysis At least two review authors independently extracted data and assessed the risk of bias. We undertook a structured synthesis. Main results We included two studies, both from the United States. People offered health insurance information and application support by community‐based case managers were probably more likely to enrol their children into health insurance programmes (risk ratio (RR) 1.68, 95% confidence interval (CI) 1.44 to 1.96, moderate quality evide...

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Section: Introductionmentioning

confidence: 99%

Strategies for expanding health insurance coverage in vulnerable populations

Jia

Yuan

Huang

et al. 2014

Cochrane Database of Systematic Reviews

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“…[12][13][14][15] Thus, retaining coverage for children who enroll in Medicaid or CHIP is critical to ensuring their continuous access to care. 16,17 Research evidence suggests that many children who disenroll from public coverage become uninsured. 18,19 Thus, by retaining children in Medicaid/CHIP for longer periods of time, states are likely to also reduce the number of uninsured children.…”

Section: Methodsmentioning

confidence: 99%

Monitoring Duration of Coverage in Medicaid and CHIP to Assess Program Performance and Quality

Kenney

Pelletier

2011

Academic Pediatrics

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Prospective and retrospective measures of duration were recommended for inclusion in the core set of quality measures. Although the prospective and retrospective measures were ranked high in terms of validity and importance by the Subcommittee on Quality Measures for Children's Health Care in Medicaid and CHIP, concerns were raised about feasibility given that no state currently uses these measures to monitor program performance. Additional technical and financial resources and enhancements to administrative data systems will be needed to support state efforts in this area of quality assessment, particularly in the areas of linking Medicaid and CHIP data files, improving reason for dis-enrollment codes, and improving race and ethnicity coding. Monitoring how well states are doing at enrolling and retaining children in Medicaid and CHIP is a critical component to assessing overall program performance and quality and for interpreting many of the other proposed quality measures.

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“…One study revealed 52 barriers to enrollment comprising 11 domains, including lack of knowledge about Medicaid/CHIP, failure to apply, language barriers, immigration status, income, income verification, misinformation from insurance representatives, system problems, hassles, decisions that were still pending, and family mobility [8]. Multiple studies document that lack of knowledge about the Medicaid and CHIP programs is one of the most important barriers to enrolling eligible uninsured children [8,9,10,11,12,13]. A Kaiser Commission on Medicaid and the Uninsured study [9] found that only 26% of parents of eligible uninsured children said that they had ever talked to someone or received information about Medicaid enrollment, and another study [7] revealed that 27% of parents of uninsured eligible children had not heard of Medicaid or CHIP.…”

Section: Introductionmentioning

confidence: 99%

“…A Kaiser Commission on Medicaid and the Uninsured study [9] found that only 26% of parents of eligible uninsured children said that they had ever talked to someone or received information about Medicaid enrollment, and another study [7] revealed that 27% of parents of uninsured eligible children had not heard of Medicaid or CHIP. Hassles (i.e., a burdensome enrollment process) also have been identified in several studies as an enrollment barrier [8–13,14]; other recurrent enrollment barriers include language barriers [7–9;13], income and income verification [8–10], and mobility [8,12]. …”

Section: Introductionmentioning

confidence: 99%

Design, methods, and baseline characteristics of the Kids' Health Insurance by Educating Lots of Parents (Kids' HELP) trial: A randomized, controlled trial of the effectiveness of parent mentors in insuring uninsured minority children11Clinical Trials.gov NCT01264718.

Flores¹,

Walker²,

Lin³

et al. 2015

Contemporary Clinical Trials

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Background & objectives Six million US children have no health insurance, and substantial racial/ethnic disparities exist. The design, methods, and baseline characteristics are described for Kids’ Health Insurance by Educating Lots of Parents (Kids’ HELP), the first randomized, clinical trial of the effectiveness of Parent Mentors (PMs) in insuring uninsured minority children. Methods & research design Latino and African-American children eligible for but not enrolled in Medicaid/CHIP were randomized to PMs, or a control group receiving traditional Medicaid/CHIP outreach. PMs are experienced parents with ≥ 1 Medicaid/CHIP-covered children. PMs received two days of training, and provide intervention families with information on Medicaid/CHIP eligibility, assistance with application submission, and help maintaining coverage. Primary outcomes include obtaining health insurance, time interval to obtain coverage, and parental satisfaction. A blinded assessor contacts subjects monthly for one year to monitor outcomes. Results Of 49,361 candidates screened, 329 fulfilled eligibility criteria and were randomized. The mean age is seven years for children and 32 years for caregivers; 2/3 are Latino, 1/3 are African-American, and the mean annual family income is $21,857. Half of caregivers were unaware that their uninsured child is Medicaid/CHIP eligible, and 95% of uninsured children had prior insurance. Fifteen PMs completed two-day training sessions. All PMs are female and minority, 60% are unemployed, and the mean annual family income is $20,913. Post-PM-training, overall knowledge/skills test scores significantly increased, and 100% reported being very satisfied/satisfied with the training. Conclusions Kids’ HELP successfully reached target populations, met participant enrollment goals, and recruited and trained PMs.

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Low-Income Uninsured Children With Special Health Care Needs: Why Aren't They Enrolled in Public Health Insurance Programs?

Cited by 26 publications

References 13 publications

Strategies for expanding health insurance coverage in vulnerable populations

Strategies for expanding health insurance coverage in vulnerable populations

Monitoring Duration of Coverage in Medicaid and CHIP to Assess Program Performance and Quality

Design, methods, and baseline characteristics of the Kids' Health Insurance by Educating Lots of Parents (Kids' HELP) trial: A randomized, controlled trial of the effectiveness of parent mentors in insuring uninsured minority children11Clinical Trials.gov NCT01264718.

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