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Children of working poor parents continue to be at a disadvantage for health care access and use

State Medicaid programs such as California's Medi-Cal provide health insurance to impoverished children. State Children's Health Insurance Programs (SCHIPs), such as California's Healthy Families, expand eligibility to include children of the working poor. Yet, despite these programs, California children from poor working families were still far less likely to be insured than other poor children and nonpoor children in 2001, according to a study supported by the Agency for Healthcare Research and Quality (HS13411).

Sylvia Guendelman, Ph.D., of the University of California, Berkeley, and her colleagues used data from the 2001 California Health Interview Survey (CHIS) to compare the health insurance coverage, access to care, and use of health care services for three groups of children: the working poor, nonworking poor, and nonpoor. Working poor families (4,440 children) were those earning less than 200 percent of the Federal poverty level (FPL, $35,300 for a family of four). Nonworking poor families (1,554 children) had an income less than 200 percent of the FPL; parents were not working and/or they relied on Temporary Assistance for Needy Families (TANF) as their main source of income. Most TANF recipients are not employed. Nonpoor families (10,534 children) earned at least 200 percent of the FPL and did not receive TANF benefits.

Compared with the non-working poor/TANF group, children of the working poor were more likely to be Latino and less likely to be black or Asian, more likely to be undocumented (and thus unable to qualify for Medi-Cal or Healthy Families), and to live in two-parent or larger households. Even after adjusting for other factors, children from working poor families were nearly three times as likely to be uninsured as children from nonworking poor/TANF families, and they were nearly four times as likely to be uninsured as nonpoor children. Children from working poor families were also more than twice as likely as nonpoor children to have their insurance coverage disrupted.

Disparities in access to and use of care among children of the working poor narrowed considerably (except for dental care) after controlling for insurance coverage. These findings attest to the importance of continuing efforts to expand health insurance coverage of the working poor.

See "Access to health care for children and adolescents in working poor families: Recent findings from California," by Dr. Guendelman, Veronica Angulo, M.P.H., and Doug Oman, Ph.D., in the January 2005 Medical Care 43(1), pp. 68-78.

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