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Randomized trial reveals community-based case managers increase public insurance enrollment of uninsured Latino children

Currently, more than a fifth of Latino children in the United States have no public or private health insurance. This rate is higher than that of any other racial or ethnic group. A new study, supported in part by the Agency for Healthcare Research and Quality (HS11305), revealed that using bilingual community-based case managers to help poor Latino children enroll in Medicaid or State Children's Health Insurance Programs (SCHIP) reduced the proportion who were uninsured, and eliminated this racial/ethnic disparity in uninsurance.

Glenn Flores, M.D., of the Medical College of Wisconsin, and colleagues randomly assigned uninsured Latino children aged 18 and younger from two Boston-area communities to either an intervention group using trained case managers or a control group receiving traditional Medicaid and SCHIP outreach and enrollment. The researchers found that 96 percent of 139 uninsured children who received the intervention enrolled in either Medicaid or SCHIP between May 2002 and September 2003, compared with 57 percent of Latino children who did not receive the intervention.

When the researchers analyzed data for the followup period, which lasted to August 2004, they found that the children assisted by case managers were more likely than children who were not to remain continuously insured (78 versus 30 percent) and significantly less likely to be sporadically insured (18 versus 27 percent) or continuously uninsured (4 versus 43 percent).

The case managers helped the children and their families by providing information about the types of available insurance programs and eligibility requirements, working with parents to complete and submit application forms, and expediting final coverage decisions by State agencies. They also acted as family advocates when children were inappropriately deemed ineligible for insurance or had coverage inappropriately discontinued.

Efforts to make families of the children assigned to the control group aware of Medicaid and SCHIP included direct mail, newspaper and radio announcements, community health fairs, providing grants to local organizations to provide outreach and assistance with applications, and establishing a toll-free telephone number that parents could call for information about applying for health benefits.

See "A randomized controlled trial of the effectiveness of community-based case management in insuring uninsured Latino children," by Dr. Flores, Milagros Abreu, M.D., Christine E. Chaisson, M.P.H., and others, in the December 6, 2005, Pediatrics 116(6), pp. 1433-41.

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