Potentially eligible Medicaid population without Medicaid coverage

Authors: –Gerry Fairbrother, PhD –Joseph Schuchter, MPH Reviewers: –Lorin Ranbom –David Dorsky –Tom Scheid

Insurance is a critical precursor for health Insurance = appropriate, quality care: medical home, regular check-ups, etc. No insurance or unstable coverage leads to individual costs: –Unmet needs, delayed care, bankruptcy and societal costs: –“A Shared Destiny”, IOM 2003

Most of the uninsured are eligible Uninsured children: FPLUninsured parents: FPL Two-thirds of uninsured children meet income requirements One-third of uninsured parents meet income requirements

Study purpose: To examine the uninsured and unstably insured parents and children who are eligible for public coverage to learn: –who they are –how they differ from insured individuals –why they are not covered

Analysis restricted to eligible children and parents Eligible children: –Households <150% FPL –Households % FPL w/out other coverage Eligible parents: –Households <100%FPL –parent, foster parent, legal-guardian, or step- parent to at least one family member aged 17 or younger living in their household

Insurance status Current status –Participating –Not participating (uninsured) –Other Year-long status –Full-year insured –Part-year insured (unstable) –Full-year uninsured (chronically)

Insurance classification of children and parents, current and year-long status

Current and year-long insurance status of eligible children and parents

Likelihood of not participating in Medicaid and being uninsured; univariate analysis

Children’s participation 77,000 eligible uninsured children –upper end of the income eligibility spectrum –have two adults in the family –of Hispanic race/ethnicity –no special health care need –rural non-Appalachian area –PARENT WHO IS NOT ON MEDICAID

Parent’s participation 105,000 eligible uninsured parents –upper end of the income eligibility spectrum –have two adults in the family –of Hispanic race/ethnicity –no special health care need –male

Likelihood of being uninsured all-year *, univariate analysis * Uninsured for a full-year compared to insured for a full-year

Unstable and chronic uninsurance Associated w/ the same characteristics predicting participation in children and parents

Why uninsured in the past 12 months?

Primary reason for being uninsured in the past 12m, percent of currently uninsured children and parents

Why no longer have Medicaid?

Primary reason for no longer having Medicaid, children and parents, by current insurance status

Why unable to get Medicaid? Why didn’t anyone try?

Primary reason child was unable to get Medicaid and family didn’t try to get, among children uninsured currently and for part or all of the past 12 months

Health utilization and needs among eligible children, by year-long insurance status

Health utilization and needs among eligible parents, by year-long insurance status

Insurance works General increase in care received and decrease in unmet needs, for both children and parents Most notable difference in the % of children with a well child visit in the last year: children with a full- year of Medicaid coverage Must be continuous to be effective: those with unstable (part-year) coverage have a level of unmet needs similar to those uninsured for a full-year

Implications address confusion among working families about eligibility requirements more linguistically and culturally sensitive outreach enable families to obtain coverage they value; few of the eligible uninsured didn’t want or need Medicaid further simplify enrollment and renewal processes to reduce burden on families and eligibility workers solutions to increase enrollment must be multi- faceted, using both simplification and outreach