Children's underenrollment in State health insurance programs may be due in part to parents' confusion about coverage

Research Activities, September 2011, No. 373

Many low-income children in the United States are eligible for public health insurance. Yet, a large number of uninsured children are not enrolled in this program, even though they are eligible and may be receiving other public assistance. A new study suggests that lack of enrollment in public health insurance programs may be due to parental confusion about whether or not their children are actually enrolled in the program. In a recent survey of Oregon parents with children eligible for public health insurance, some parents thought their children were enrolled when they were not. Other parents believed their children were not enrolled when, in fact, they were enrolled.

If Medicaid and the Children's Health Insurance Program (CHIP) are to be pillars in future health insurance reforms, efforts must be made to provide stable coverage and a system that boosts parental knowledge of their children's eligibility and enrollment status, assert Jennifer E. DeVoe, M.D., D.Phil., and Oregon Health & Science University colleagues. They examined administrative enrollment data from the Food Stamp Program in Oregon (FSP) and from the Oregon Health Plan (OHP), which is the State's Medicaid-CHIP. They also mailed surveys to a stratified, random sample of 10,175 households participating in the FSP that had at least one child aged 1 year or older to determine whether parents of children enrolled in the FSP had also enrolled their children in the Oregon Health Plan.

Researchers observed a surprising number of discrepancies between parental report and State records with regard to their children's enrollment status in the OHP. For example, 171 (11.3 percent) parents reported that their child was not enrolled in the OHP, while State records indicated they were enrolled. Similarly, 252 (21.2 percent) parents reported their child was enrolled, but the State enrollment records did not show them to be enrolled.

Children most likely to have eligibility confusion had uninsured parents, were from families earning more than $1,000 per month, had parents employed outside the home, and had no usual source of care. The study was supported in part by the Agency for Healthcare Research and Quality (HS16181).

See "Public health insurance in Oregon: Underenrollment of eligible children and parental confusion about children's enrollment status," by Dr. DeVoe, Moira Ray, B.S., and Alan Graham, M.D., in the May 2011 American Journal of Public Health 101(5), pp. 891-898.

Current as of September 2011
Internet Citation: Children's underenrollment in State health insurance programs may be due in part to parents' confusion about coverage: Research Activities, September 2011, No. 373. September 2011. Agency for Healthcare Research and Quality, Rockville, MD.