Targeted Outreach Key to Insuring Children, HSC Report Finds

Though low-income U.S. children now have "near-universal eligibility" for health coverage through CHIP, Medicaid and employer-based coverage, the uninsured rate remains high due to low enrollment in public programs, indicating that the key to improving coverage for this population is better outreach, not expanded eligibility, Peter Cunningham, a senior health researcher at the Center for Studying Health System Change, writes in a Health Affairs Web-exclusive study. According to data from the HSC's 1996-1997 and 1998-1999 Community Tracking Study household surveys, the rate of low-income children -- those in families with incomes less than 200% of the federal poverty level -- eligible for public health coverage jumped from 63% to 92% after lawmakers enacted the CHIP program in 1997. However, the "take-up rate" for public programs, or the proportion of low-income children enrolling, remained low at 42% in 1998-99. In addition, some communities, largely in southern and western states, still have "very high" rates of uninsured children, which Cunningham attributed in part to the "stigma" of enrollment in public programs, "complexities" in the application process, "confusion or apathy" about eligibility requirements and cost-sharing provisions in some states. Cunningham also noted that high-uninsurance communities -- defined as those with more than 16% of children uninsured -- tend to have a relatively large Hispanic population compared to low-uninsurance communities, indicating that immigration concerns or language barriers may also play a role in low take-up rates (Cunningham, HealthAffairs.org, 7/25). "The road to insuring all low-income children is no longer expanding eligibility; it's getting states and communities to reach out and find these kids and encouraging parents to enroll them in existing public health programs," Cunningham said, adding, "There's no magic solution" (HSC release, 7/25). The study, "Targeting Communities with High Rates of Uninsured Children," is available online. Note: You must have Adobe Acrobat Reader to view the study.